How to help employees get the most out of their health benefits

When employees understand their health costs, it can save your organization money. Studies suggest, however, that most consumers with health coverage don’t fully understand their health plans.

“Employees need to understand what their insurance plan covers and what it doesn’t,” says Amber Hulme, Medical Mutual Vice President, Central and Southern Ohio. “With the right information, they can reduce health care costs for themselves, as well as their employer.”

Smart Business spoke with Hulme about what employees must understand about their health care coverage, how common misconceptions can affect medical costs and what simple steps can make the most difference.

What resources can help employees better understand their benefits?

There are two key documents your employees should know. First, all employees get a benefit book or certificate of coverage, which explain what medical services are covered — and not covered — under the plan. Employees should look up every service or supply that might apply to their needs. It’s important for employees to be familiar with this document so they aren’t surprised if a particular service is not covered.

The second document is called an Explanation of Benefits (EOB). After employees receive services, they should read their EOB to make sure they understand what they’re paying for. Organizations can encourage employees to call their insurance company’s customer service department with questions.

Why is checking the network so important?

Doctors and hospitals work with insurance carriers to negotiate rates, which is a big factor in how much members have to pay for care. Employees receiving services outside the network often have to pay any balance beyond what the insurance carrier pays. But by staying in network, they only pay their copay and any deductible or coinsurance that applies.

Many people don’t realize, however, that a provider’s network status can change. Health insurance members can make sure their doctor is in network by calling a customer hotline or going online and searching an easy-to-use provider directory.

What should employees know about their options for care?

First, employees need to know their options in non-emergency situations. When employees get injured or feel ill, their first instinct is often to visit the emergency room. But it’s not always the best choice. When it’s not an emergency, a visit to a primary care doctor could cost half as much as a trip to the ER — or less.

Urgent care facilities and convenience clinics are also great options for common illnesses such as a cold or flu, as well as infections, allergic reactions, minor cuts, burns and sprained muscles. Employees can get prescriptions filled and vaccinations.

Another important consideration is when employees need to get a blood test or have other lab work done. In many cases, they will automatically go to the lab that’s inside the hospital or affiliated with their doctor’s office. But there are options. Independent labs, for example, can often provide the same tests and the same level of service at a lower cost. Your insurance carrier should have tools that can help employees find other options that may be better for them and help them save money.

How can you effectively present benefits to your employees?

Communicating benefits clearly to employees is crucial in their understanding of health coverage. Benefit presentations are one of the best ways to educate employees.

To maximize interest, organizations need to make their presentations interactive and use visuals. Be open to any questions and present information in short segments to avoid confusion. After the presentation, refresh the topic by regularly emailing your employees with benefit reminders and updates.

The key is to give employees the resources they need — how to reach their insurance carrier, useful websites and where to look for their certificate of coverage or EOB.

Be open to communication and always encourage employees to ask questions.

Insights Health Care is brought to you by Medical Mutual