Make the better decision

The fall season is the time when about
80 percent of employers hold their
open enrollments. This annual event allows employees to ask questions and
choose the health plan best suited for their
families’ needs. Choosing a health care
plan is no longer just a health care decision, it is a financial decision.

“This is about setting your annual health
care budget,” says Don Whitford, director
of sales and client services with Priority
Health. “It is important to prepare for the
‘what if’ in medical care.”

Smart Business spoke with Whitford
about how employers should help employees prepare for open enrollment and how
to make open enrollment successful for
employers and employees.

How can employers prepare for open enrollment?

Communication should be constant.
Employers should inform their employees
about the types of plans being offered. The
financial aspects of the plan should be disclosed as early as possible. Employees
should be informed if they are expected to
contribute for plan coverage and what outof-pocket costs can be expected.

How should employees utilize open enrollment?

Employees should track their coverage
needs from the previous year and then document how their current plan covered such
needs. During open enrollment, you can
compare how other plans would have covered the same needs. You should use this
period to talk with the representatives at
your health plan provider and let them help
you figure out which plan will cover your

What should employees ask their carrier
when trying to select a plan?

The network — They should ask questions to fully understand which physicians
are in the network. Employees should
make sure they are comfortable switching
physicians if their current physician is not
in their network.

Co-pays and deductibles — Employees
need to know what their out-of-pocket costs
are with their plan. They also need to understand what is and what is not covered.

The drug formulary — Every plan uses a
drug formulary (see Smart Business
September 2008), but different health plans
cover different drugs. This must be understood by the employee especially if he or
she is switching from one benefit plan to

The customer service policy — When the
employee calls in with a question, to whom
will he or she speak? How quickly can the
employee expect resolution to his or her
problem? What is the percentage of calls
that are resolved on the first call?

How can employers make the open enrollment process easy and effective for their

Many employers make the mistake of not
taking advantage of the resources their carriers provide. As a business owner, you are
not required to be an expert on the health
care plans you provide your employees.
However, you are responsible for providing
the proper resources to help employees make the best decisions. An employer
should allow the carrier to have its representatives address the employees. Schedule
on-site walk-in sessions for your employees
to meet with representatives from the
health plan. The frequency of these sessions
will depend on the size of your work force.
Employers should also open communication to employees’ families.

What educational information should be provided to employees before and during open

Carriers should be able to provide crisp,
concise benefit summaries. The carrier
should have a user-friendly Web site that
provides information on a number of topics such as the drug formulary and how
benefit designs work. The employer should
provide the pricing information for the
employees. The key is to be open with all
information and how the plans work as
early as possible so that employees have
enough time and information to make a
well-educated decision.

Are there certain areas within a plan that
employees should evaluate in an attempt to
save money?

These areas may vary between each
employee depending on his or her personal
needs. That is why it is important to track
and identify those needs. There are a few
key areas where employees can look to
save money. The first area is the deductible.
Which services have deductibles or co-pays? What are the amounts of these co-pays? How often do I use these services?
Are the competitors’ co-pays significantly

For employees with younger children, it
is beneficial to look at the carrier’s coverage for preventive measures such as vaccines and routine checkups. Some carriers
only allot a certain amount of funds for preventive services. After the employee’s fund
is capped, then all preventive measures
become an out-of-pocket expense for the

DON WHITFORD is the director of sales and client services with Priority Health. Reach him at [email protected] or (248)