A health insurance primer for your employees during Open Enrollment
The end of open enrollment season is quickly approaching. During open enrollment, employees have the chance to choose a benefits plan or change from the plan they currently have. Read this blog post for a few things employees should consider when choosing a plan.
Now is the time to choose the best health plan for you and your family. During open enrollment season, employers and the Health Insurance Marketplace (or Exchange) let you choose a plan or change from the plan you have. Making the right choice can impact your health and your wallet.
Even if your current coverage seems satisfactory, your employer or the Exchange may offer new options that better suit your needs. It is important to compare costs and to understand differences in benefits, networks and other rules. In some states, plans available outside the official Marketplace offer attractive, low premiums but may have dollar limits on benefits, or may not provide coverage for childbirth, mental health and other services mandatory for plans that qualify under the Affordable Care Act (the “ACA” or “Obamacare”). Review and compare such plans’ terms carefully.
The time for your decision is limited. Employers generally provide a month or more to make your selection. Open enrollment for the federal Marketplace runs only from November 1, 2019, to December 15, 2019. Exceptions may be made for life changes like the birth of a child or loss of coverage under a spouse’s plan, but if you miss open enrollment season, you will probably have to wait another year to enroll. Here are some things to think about when choosing a plan.
Costs
The first cost to consider is the premium — the payment, usually monthly, to maintain coverage. If you get your plan through your job, your employer may pay all or part of the premium. If you choose a Marketplace plan, you may qualify for a premium tax credit to reduce the premium.
Other insurance costs are known as cost sharing, because you share the cost of care with your plan. They may take the form of a copay (a fixed dollar amount for each service), coinsurance (a set percentage of the cost of a service) or a deductible (the amount you must pay before your plan starts paying for services). If you select a Marketplace plan, you may qualify for cost-sharing reductions to lower those expenses.
In principle, it would be nice if all the costs were as low as possible. But usually, low-cost sharing comes with a high premium. High-deductible health plans may offer lower premiums but you will pay more out-of-pocket before your insurance pays anything.
In shopping for a health plan, consider how high a premium you are willing to pay for the level of cost sharing you would like. For example, if you or a family member have a chronic illness, you may need regular treatment and may be at risk for hospitalization. In that case, you may be willing to pay a higher premium for low-cost sharing. But if you are a healthy, young, single adult who rarely sees a doctor, you might accept a high deductible in exchange for a low premium.
Bear in mind that if you have a high-deductible health plan, you might be eligible to set up a health savings account (HSA). An HSA provides tax savings that stretch the dollars you contribute to the account to help pay for qualified medical expenses.
Choice of Doctors
If you like your current doctors and want to keep seeing them, make sure they and their facilities belong to the network of providers who have contracted with the plan you are considering. Check the plan’s online provider directory to make sure those doctors and their facilities are listed in its network. Even if you do not have a regular doctor, make sure the network includes providers close to where you live and work.
If you want to choose freely among many providers, a plan with a broad network might be for you. That may be more expensive than a plan with a narrow network, which may cost less but has a more limited choice of providers.
Out-of-Network Coverage
As good as a plan’s network might be, you may still wish to consult providers outside the network from time to time. If so, consider a Preferred Provider Organization (PPO) or Point of Service (POS) plan; each provides out-of-network benefits. With such plans, you will still spend more for out-of-network than in-network care, but at least you will have some coverage. Two other types of plans, Health Maintenance Organization (HMO) and Exclusive Provider Organization (EPO), typically will not pay for out-of-network care except for emergencies.
Who’s in Charge of Your Care?
In HMO and POS plans, you choose a primary care physician (PCP) who acts as a form of “gatekeeper” for your care. Unless it is an emergency, when you need medical treatment, you go to the PCP first. The PCP either treats you personally or refers you to specialists in your network. If you like having a PCP’s guidance, this arrangement might work for you. But if you prefer choosing specialists directly, you might opt for a PPO or EPO.
ACA-Compliant versus Association and Short-Term Plans
Whatever plan you choose, it is important to consider whether it covers all the types of healthcare you might need and whether it limits the dollar amount of your coverage. Plans that comply with the ACA are comprehensive because they have to cover 10 essential health benefits. Short-term, limited-duration (STLD) health plans, do not have to cover all those benefits. They may, for example, not cover childbirth, mental health or prescription drugs. If you end up needing care that is not covered, you will have to pay the whole cost yourself.
AHPs and STLD plans differ from ACA-compliant plans in other ways. For example, STLD plans can impose annual or lifetime dollar limits on coverage. If your care costs more than those limits, you have to pay the excess amount.
SOURCE: Gelburd, R. (5 December 2019) "A health insurance primer for your employees during Open Enrollment" (Web Blog Post). Retrieved from https://www.benefitnews.com/opinion/a-health-insurance-primer-for-your-employees-during-open-enrollment
5 things small business owners should know about this year's open enrollment
The benefits small business owners offer are crucial to the way they attract and retain employees. Read this blog post for five things small business owners should know for 2019 open enrollment.
As a small business owner, offering competitive employee benefits is a crucial way to attract and retain strong talent. Whether you currently provide them and are planning next year’s renewal, or you are thinking of offering them for the first time, here are five things you should consider before your employees enter the open enrollment period for next year on November 1st:
1. Small businesses don’t have to wait until open enrollment to offer benefits to their employees
While your employees won’t be able to enroll in health insurance plans until November comes along, small business owners don’t have to wait at all to secure health insurance for their employees. The sooner you act, the better, to guarantee that you and your employees are protected. According to recent studies, healthier employees are happier employees, and as a result, will contribute to a more productive workplace. And a more positive and constructive work environment is better for you, your employees, and your business as a whole.
2. Health literacy is important
Whether you’ve provided health insurance to your employees before, or you’re looking into doing so for the first time, it is always worthwhile to prioritize health insurance literacy. There is a host of terminology and acronyms, not to mention rules and regulations that can be overwhelming to wrap your head around.
Thankfully, the internet is full of relevant information, ranging from articles to explainer videos, that should have you up to speed in no time. Having a good understanding of insurance concepts such as essential health benefits, employer contributions, out-of-pocket maximums, coinsurance, provider networks, co-pays, premiums, and deductibles is a necessary step to being better equipped to view and compare health plan options side-by-side. A thorough familiarization with health insurance practices and terms will allow you to make the most knowledgeable decisions for your employees and your business.
3. Offering health insurance increases employee retention
Employees want to feel like their health is a priority, and are more likely to join a company and stay for longer if their health care needs are being met. A current survey shows that 56 percent of Americans whose employers were sponsoring their health care considered whether or not they were happy with their benefits to be a significant factor in choosing to stay with a particular job. The Employee Benefit Research Institute released a survey in 2016 which showed a powerful connection between decent workplace health benefits and overall employee happiness and team spirit—59 percent percent of employees who were pleased with their benefits were also pleased with their jobs. And only 8 percent of employees who were dissatisfied with their benefits were satisfied with their jobs.
4. Alleviate health insurance costs
High insurance costs can be an obstacle for small business owners. A new survey suggests that 53 percent of American small business owners stress over the costs of providing health care to their employees. The 2017 eHealth report reveals that nearly 80 percent of small businesses owners are concerned about health insurance costs, and 62 percent would consider a 15 percent increase in premiums to make small group health insurance impossible to afford. However, there are resources in place to help reduce these costs, so they aren’t too much of a barrier. One helpful way to cut down on health insurance costs is to take advantage of potential tax breaks available to small business owners. All of the financial contributions that employers make to their employees’ premiums are tax-deductible, and employees’ financial contributions are made pre-tax, which will successfully decrease a small business’ payroll taxes.
Additionally, if your small business consists of fewer than 25 employees, you may be eligible for tax credits if the average yearly income for your employees is below $53,000. It is also beneficial to note that for small business owners, the biggest driver on insurance cost will be the type of plan chosen in addition to the average age of your employees. Your employees’ health is not a relevant factor.
5. Utilize digital resources
You don’t have to be an insurance industry expert to shop for medical plans. There are resources and tools available that make buying medical plans as easy as purchasing a plane ticket or buying a pair of shoes online – Simple, transparent. Insurance is a very complex industry that can easily be simplified with the use of the advanced technology and design of online marketplaces. These platforms are great tools for small business owners to compare prices and benefits of different plans side-by-side. Be confident while shopping for insurance because all of the information is laid out on the table. Technological solutions such as digital marketplaces serve as useful tools to modernize the insurance shopping process and ensure that you and your team are covered without going over your budget.
SOURCE: Poblete, S. (15 October 2018) "5 things small business owners should know about this year's open enrollment" (Web Blog Post). Retrieved from https://www.benefitspro.com/2018/10/15/5-things-small-business-owners-should-know-about-t/
How to Optimize Open Enrollment for Workers
From the rising cost of prescription medications to the ever-changing status of the ACA, benefit administrators are faced with many challenges when it comes to healthcare programs. Read this blog post to learn more.
Administrators of employer-sponsored healthcare programs face myriad challenges these days, from the rising cost of medications to the fluctuating status of the Affordable Care Act and state healthcare exchanges. As we head into the 2019 open enrollment season, it’s clear that these issues will continue to impact every type and rank of employee in the coming year.
To that end, I’ve outlined several key trends in open enrollment that frazzled HR leaders should explore before enrollment season begins. If it’s too late to make changes to your program this year, use these key points as a basis for measuring and evaluating current programs so you can begin planning for a more engaging, transparent and streamlined process next year.
You don’t have to take it all on yourself.
Employers are realizing that as great as some decision support and health advocacy tools may be, attempts to make employees better healthcare consumers have been only marginally effective. High-performing (aka narrow) networks may be a viable solution as they enable better rates negotiated with the carriers and providers while reducing waste, errors and unnecessary costs. It’s the steerage option, but plan designs can provide incentives for employees to elect these plans and networks. In turn, the HPNs can provide:
- more concierge-like service;
- better coordinated care between providers for high-cost claimants—where much of runaway costs reside; and
- support to ensure compliance with treatment protocols—for chronic conditions such as diabetes, CAD, COPD, etc.
In turn, these plans have the potential for shaving points off healthcare cost trend.
But it’s vital that communication strategies help reduce fears of reduced network choices (avoiding bad memories of restrictive HMO networks) while increasing confidence in the ability of the HPNs to drive results that actually enhance care while also reducing costs.
The best strategy is to provide easy-to-understand examples and scenarios that represent typical situations based on your company’s demographics and employee personas.
Use all the channels you have.
Education and engagement need to be done through a variety of channels to address the specific needs and preferences of demographic groups. Employees need to compare their options based on anticipated needs to look at both premiums (per paycheck costs) and out-of-pocket costs (deductible, copays, coinsurance), as well as employer-provided HSA contributions and incentives. The premium doesn’t tell the whole story—some people over-insure themselves by paying a higher premium for coverage that they may not use because they fear a higher deductible and out-of-pocket maximum.
Cost-comparison tools, interactive personalized assessment tools, microsites that are mobile-optimized with clear, consistent messaging, and extremely brief interactive videos make the message relevant to each individual.
Remember too that your company portal is both a useful tool in ensuring a personalized message to the employee, and a way for you to collect aggregated data about your employees’ interests, needs, action or inaction, and the user experience.
Don’t try to hit all the bases.
Trying to communicate too much information at one time tends to obscure the key message. Focus only on providing information needed to make effective enrollment decisions and use other points during the year to educate about broader topics like wellness.
A common failure is going paperless and forgetting that you really need to drive employees to resources to get them to pay attention. There may be very robust online content and resources but a very low rate of use of that valuable information. Remember that spouses at home often may be making the majority of the healthcare decisions for a family or, at the very least, for themselves. So going too far with the paperless approach can miss getting the message—and the needed information—to those key stakeholders.
Don’t fear transparency.
It’s intriguing to me that some employers are wary about communicating their level of cost-sharing with employees and how it benchmarks against peer companies. Employees often assume they are paying a far larger share than they are. There are other ways of being transparent about cost-sharing beyond the employer-employee split. For instance, we created an infographic for a client to explain the concept of self-insurance and are using it in an ongoing educational series with fact sheets and videos, getting across the idea that the decisions each of us make about our health and informed healthcare purchasing affect the costs in our individual as well as collective pockets.
The bottom line is that helping employees get smart about how they use healthcare and choose insurance options will save your company money. That’s not as callous as it sounds. If employers can’t find more and better ways to control healthcare and benefits costs, they’ll simply have to shift more of the burden to employees. Healthcare access is onerous enough. No one wants to make it harder or deprive workers of needed care. Healthy, satisfied, financially stable workers are better for business, productivity and the overall economy. Commit to exploring these key trends and making meaningful improvements to open enrollment in 2019 and beyond.
SOURCE: Brooks, B. (16 October 2018) "How to Optimize Open Enrollment for Workers" (Web Blog Post). Retrieved from https://hrexecutive.com/how-to-optimize-open-enrollment-for-workers/
5 ways employers can leverage tech during open enrollment
Are you leveraging technology advancements during open enrollment? Advances in technology are creating a more seamless and interactive healthcare experience for employees. Read on for five ways employers can leverage technology during 2019 open enrollment.
Technology continues to reshape how employers select and offer healthcare benefits to employees, putting access to information at our fingertips and creating a more seamless and interactive healthcare experience. At the same time, these advances may help employees become savvier users of healthcare, helping simplify and personalize their journey toward health and, in the process, help curb costs for employers.
The revolution can be important to remember during open enrollment, which occurs during the fall when millions of Americans select or switch their health benefits for 2019. With that in mind, here are five tips employers should be aware of during open enrollment and year-round.
Make sense of big data
Help people understand their options
Encourage your people to move more
Offer incentives to employees who comparison shop for care
Integrate medical and ancillary benefits
5 things small business owners should know about this year's open enrollment
For small business owners, the benefits they offer are crucial to the way they attract and retain employees. Read this blog post for five things small business owners should know for 2019 open enrollment.
As a small business owner, offering competitive employee benefits is a crucial way to attract and retain strong talent. Whether you currently provide them and are planning next year’s renewal, or you are thinking of offering them for the first time, here are five things you should consider before your employees enter the open enrollment period for next year on November 1st:
1. Small businesses don’t have to wait until open enrollment to offer benefits to their employees
While your employees won’t be able to enroll in health insurance plans until November comes along, small business owners don’t have to wait at all to secure health insurance for their employees. The sooner you act, the better, to guarantee that you and your employees are protected. According to recent studies, healthier employees are happier employees, and as a result, will contribute to a more productive workplace. And a more positive and constructive work environment is better for you, your employees, and your business as a whole.
2. Health literacy is important
Whether you’ve provided health insurance to your employees before, or you’re looking into doing so for the first time, it is always worthwhile to prioritize health insurance literacy. There is a host of terminology and acronyms, not to mention rules and regulations that can be overwhelming to wrap your head around.
Thankfully, the internet is full of relevant information, ranging from articles to explainer videos, that should have you up to speed in no time. Having a good understanding of insurance concepts such as essential health benefits, employer contributions, out-of-pocket maximums, coinsurance, provider networks, co-pays, premiums, and deductibles is a necessary step to being better equipped to view and compare health plan options side-by-side. A thorough familiarization with health insurance practices and terms will allow you to make the most knowledgeable decisions for your employees and your business.
3. Offering health insurance increases employee retention
Employees want to feel like their health is a priority, and are more likely to join a company and stay for longer if their health care needs are being met. A current survey shows that 56 percent of Americans whose employers were sponsoring their health care considered whether or not they were happy with their benefits to be a significant factor in choosing to stay with a particular job. The Employee Benefit Research Institute released a survey in 2016 which showed a powerful connection between decent workplace health benefits and overall employee happiness and team spirit—59 percent percent of employees who were pleased with their benefits were also pleased with their jobs. And only 8 percent of employees who were dissatisfied with their benefits were satisfied with their jobs.
4. Alleviate health insurance costs
High insurance costs can be an obstacle for small business owners. A new survey suggests that 53 percent of American small business owners stress over the costs of providing health care to their employees. The 2017 eHealth report reveals that nearly 80 percent of small businesses owners are concerned about health insurance costs, and 62 percent would consider a 15 percent increase in premiums to make small group health insurance impossible to afford. However, there are resources in place to help reduce these costs, so they aren’t too much of a barrier. One helpful way to cut down on health insurance costs is to take advantage of potential tax breaks available to small business owners. All of the financial contributions that employers make to their employees’ premiums are tax-deductible, and employees’ financial contributions are made pre-tax, which will successfully decrease a small business’ payroll taxes.
Additionally, if your small business consists of fewer than 25 employees, you may be eligible for tax credits if the average yearly income for your employees is below $53,000. It is also beneficial to note that for small business owners, the biggest driver on insurance cost will be the type of plan chosen in addition to the average age of your employees. Your employees’ health is not a relevant factor.
5. Utilize digital resources
You don’t have to be an insurance industry expert to shop for medical plans. There are resources and tools available that make buying medical plans as easy as purchasing a plane ticket or buying a pair of shoes online – Simple, transparent. Insurance is a very complex industry that can easily be simplified with the use of the advanced technology and design of online marketplaces. These platforms are great tools for small business owners to compare prices and benefits of different plans side-by-side. Be confident while shopping for insurance because all of the information is laid out on the table. Technological solutions such as digital marketplaces serve as useful tools to modernize the insurance shopping process and ensure that you and your team are covered without going over your budget.
SOURCE: Poblete, S. (15 October 2018) "5 things small business owners should know about this year's open enrollment" (Web Blog Post). Retrieved from https://www.benefitspro.com/2018/10/15/5-things-small-business-owners-should-know-about-t/
Here’s how HR pros can breeze through open enrollment
Does open enrollment make your HR department tremble with fear? Open enrollment season is right around the corner and can make the most experienced HR professionals shudder. Read on to learn how your HR department can breeze through open enrollment this year.
Three words have the power to make the most experienced HR professional shudder: open enrollment season.
Open enrollment season is a challenge, no matter how well the HR department prepares. Costs for medical and pharmacy benefits continue to rise, which means there are adjusted employee contributions to present to an audience who’s unlikely to understand the reasoning behind cost increases. There may be new benefits offerings that require employees to pay close attention during the decision-making process. There are open enrollment education campaigns and communications meetings to plan and launch.
Employers with multiple generations of workers must accommodate a wide range of health and welfare benefit needs. New laws (like the federal tax law) plus evolving regulations around benefits add more to HR’s already full plate. (No wonder you don’t have time for lunch.)
But, there’s good news. First, open enrollment is made easier if you plan throughout the year for it. Second, these four tips can help HR professionals make open enrollment much easier.
Review trends and projections ASAP. Focus on the renewal rate long before the renewal date. If your employee benefits renew at the beginning of the year, you may not have received your rate yet. But frankly, by now you should have a very good idea where the rate is projected to land. Reviewing claims and trend data alongside benchmarking and industry analyses throughout the year can help you and your broker project, within a few percentage points, how your renewal rate will increase or decrease.
Your benefits broker should be analyzing your program data on an ongoing basis to estimate the renewal rate and avoid a nasty surprise. The broker should also challenge the first carrier rate offered — there’s almost always room for negotiation. Doing pre-renewal work throughout the year can help you prepare for plan changes and position you to make the best decisions for the organization and employees. It will also help facilitate a smoother open enrollment season.
Keep new benefit options simple. After reviewing benefits and trends, you may find that adding a pre-tax benefit, such as a health savings account, flexible spending account or a health reimbursement account, can help the organization save money while giving employees a way to better plan their healthcare and finances. However, with their alphabet soup acronyms, HSAs, FSAs and HRAs are confusing. Even if you did a whole campaign on the topic for the last open enrollment season, it makes sense to repeat it.
The same goes for voluntary benefits: keep them simple. There is a dearth of voluntary benefits available for a multi-generational workforce. While adding voluntary benefit sounds appealing —especially if your core benefits are changing — which products are right for your organization? Survey your employees to get their feedback; they’ll appreciate that you’re asking for their opinion. Once you tally the feedback, resist the urge to offer a slew of voluntary products. Keeping it simple means adding the one (or a few) that are most desired by your workforce.
Voluntary benefits require significant education and engagement — especially products that are newer to the market. (Student loan debt assistance is a good example.) When it comes to a successful voluntary benefits program, timing is everything. If you plan to add student loan debt repayment, pet insurance, long-term care, or any other new voluntary product, the open enrollment season is not the recommended time to do it. Running a voluntary education and communications campaign and open enrollment off cycle will allow employees to focus on their main menu of options during the open enrollment season, then decide later what they want to add for “dessert.”
Educate. Rinse and repeat. You offer employee benefits to help recruit and retain the best talent. But if your employees don’t understand the core and voluntary benefits you offer, you’re unlikely to increase engagement or retention — and you might even see costs rise.
The health and welfare benefits landscape is changing drastically, which means the onus is on the employer and the HR department to educate the workforce on how the plan is changing (if at all). This means putting decision-support tools, such as calculators, in employees’ hands to help them estimate how much insurance they will need to make the best decision. You could run a whole campaign around that topic.
In addition, try using new methods of communication such as social media messages, text messaging, small-group meetings, your company’s intranet, and one-on-one sessions to help employees avoid mistakes at decision time.
Create a 21st-century experience. Manual benefits enrollment and tracking is so 1999. Moving away from paper-based enrollment will save trees — and possibly your sanity — during the open enrollment season and throughout the year. Benefits administration technology allows employees to ponder their options and enroll at their leisure. A decision-support platform enables better enrollment tracking and eliminates typos and mistakes that can pose major issues for the plan participant and the HR team.
Benefits administration technology provides checks and balances that streamline important tactical functions. Mistakes can put you in a world of hurt when it comes to benefit laws and regulations, such as missing those all-important annual HIPAA and COBRA notifications. You can avoid potential government penalties, fines and employee lawsuits with automatic notifications by the benefits administration platform. Technology can also help you identify ineligible dependents, provide employee data to a COBRA provider if employment ends, interface with your payroll platform — the list is almost endless.
The bottom line: Employees won’t enroll in what they don’t understand — which could lead them to choose a benefits plan that is more expensive, or with fewer options, than what they need. Being prepared for open enrollment season, keeping plans simple, focusing on employee education and communications (and the employee experience) can help mitigate issues for plan participants and HR.
Putting all of your ducks in a row throughout the year will ease headaches during the open enrollment season. You might even be able to take a lunch break.
SOURCE: Newman, H (30 August 2018) "Here’s how HR pros can breeze through open enrollment" (Web Blog Post). Retrieved from https://www.benefitnews.com/opinion/how-human-resources-can-breeze-through-open-enrollment?feed=00000152-a2fb-d118-ab57-b3ff6e310000