When it comes to healthcare benefits, there’s a big gap between what you think your employees understand and what they actually understand. The good news? Open enrollment is the perfect time to bridge this gap with proactive communications and education.
If you think benefits literacy isn’t an issue in your organization, consider this: Research from Quantum Health revealed that 88% of employers believe their workers are confident in understanding their healthcare benefits. However, only 52% of individuals surveyed say they feel confident. Meanwhile, only 45% find it easy to use their healthcare benefits, and only 35% find it easy to navigate the healthcare system.
Unfortunately, these employee knowledge gaps can negatively influence benefits adoption, utilization, engagement and compliance with care plans – all of which are metrics used to track benefits program success.
Managing benefits is an increasingly tall task
In your efforts to attract and retain talent, as you battle your way through what some are now calling the Great Renegotiation, offering an increasingly wider selection of benefits seems like the right thing to do – after all, you need to satisfy the diverse needs of several demographic groups. Unfortunately, more benefits add more confusion to the mix for employees. Meanwhile, managing those programs is becoming an increasingly tall task for your team.
One complement to your benefits program that you may have adopted, or that you may be considering, is healthcare navigation. Select navigation solutions that include care coordination provide a personalized approach to benefits by directing employees to the right in-network provider, helping solve claims issues and offering clinical support for even the most complex conditions. This alleviates the burden for you and your employees. Healthcare navigation has also been shown to increase adoption and engagement in benefits, support employees through their healthcare journey, deliver better health outcomes and reduce healthcare costs – without adding to the workload of your benefits team.
5 common healthcare benefits challenges
Even the best-laid benefit plans will underperform if employees aren’t engaged and if they don’t use benefits properly. Fortunately, open enrollment is a perfect time to educate and engage employees in company-sponsored benefits.
To help focus your efforts and influence employee behavior throughout the year, be sure your open enrollment communications proactively address what employees say are the five most common challenges they experience when using health benefits.
Finding coverage details
The key to appropriate benefits utilization is understanding coverage details, including plan type (e.g., HMO, PPO or high-deductible health plan), how copays and coinsurance work, and how deductibles work. Communicate early and often to employees and make coverage details easily accessible within the Summary Plan Description or your organization’s online benefits portal.
Finding doctors and accessing care
Awareness of their plan type and network is the first step to finding in-network providers and accessing care. Unfortunately, employees continue to have difficulty with this step. Work to educate employees about how to find a doctor, research provider cost and quality, and understand telehealth options for their chosen plan and network. If you offer healthcare navigation with care coordination, not only will you ensure employees get the care they need at the right time and within their covered benefits, you’ll avoid missteps that can generate unnecessary costs or delays in care. And your employees will also benefit from early intervention that can improve their health outcomes.
Deciphering EOBs and bills
If you had a dime for every time you received a question about a health plan Explanation of Benefits (EOB) or provider bill, what would you do? While these questions may be burdensome for benefits teams, know that EOBs are worrisome for employees if they don’t understand what it means and how it relates to the actual invoices they receive from care providers. Consider creating a sample EOB to help explain to employees how this document works and how to reconcile their EOB with the bills they receive from providers. It’s important that employees understand never to pay for services until reconciling their bill against their EOB.
Securing prior authorizations and referrals
Employees with limited healthcare needs likely won’t know if they need prior authorization or a referral for certain clinical services, prescription drugs or certain types of medical equipment. However, failure to secure a prior authorization can impact their coverage, which makes this information essential. Healthcare navigation with care coordination can ease this burden by facilitating prior authorizations on behalf of employees.
Test results and treatment options
Accessing and understanding test results and treatment options is scary and foreign to most people. Use open enrollment to demonstrate how to use a patient portal and educate employees about the valuable information it can provide. This is also a good opportunity to inform employees about supportive services available to them through the health plan or healthcare navigation partner.
Now that open enrollment is underway and that well-crafted employee benefits program you’ve worked so hard to build is on display for all to see and experience, ensure your success by taking time to educate employees on the factors that pose the biggest challenges. Investing in education and providing hands-on support through healthcare navigation will create a more personalized experience for employees. And in the process, you can improve benefits adoption and utilization, support talent retention and contribute to the financial performance of your organization.