Ten timely tips Featured

5:07am EDT July 30, 2006
With open enrollment just around the corner and all of the health benefits choices available to you and your employees, many people do not fully understand their benefits package. Sometimes the information presented to the employee can be overwhelming or not user-friendly, or employees are not sure what is and isn’t covered by their plan.

“In the midst of gathering information, the problem is not a lack of data, but, sometimes, too much data,” says Bill Berenson, vice president of sales and service for Aetna’s North Central Region. “Employees need a resource to go to that will help streamline the decision-making process, and offer tips, tools and information to employees at all stages of life, such as www.PlanforYourHealth.com.”

Smart Business asked Berenson his top 10 tips for employees when it comes to making decisions regarding their health benefits.

  • Know the four C’s of open enrollment. For most Americans, open enrollment comes around once a year. That is why it’s important for your employees to take the time to make the best decision for themselves and their families. Employees should learn what the cost of premiums and copayments will be; the coverage information -- including in-network doctors -- the current plan options -- these may change from year to year -- and the choices, such as Health Savings Accounts (HSA’s) or Health Reimbursement Arrangements (HRA’s).

  • Do a plan comparison to review copayments, coinsurance and out-of-pocket expenses. Premiums for high-deductible health plans are often lower than for other health plans. If the benefits plan has high out-of-pocket costs, employees might consider participating in a Flexible Spending Account or Health Savings Account, if one is available.

  • Choose a plan that fits medical and financial needs. Employees need to ask themselves if the plan they pick fits their medical and financial needs. Some questions to ask: Can I see a specialist without a referral? Will I be limited by the plan’s list of preferred or in-network doctors? What is the total cost of the plan including premiums, copayments, or coinsurance and deductibles?

  • Don’t underestimate the benefit of wellness. One of the primary functions of health benefits is to help keep employees healthy. Employees should check to see if the plan will offer coverage for annual checkups, well-woman and well-child visits. They should also check for coverage or discounts for exercise programs, smoking-cessation clinics, flu shots and mental health services.

  • Consider benefits as life changes occur. Getting married or having a baby can bring about big changes in health care benefits. For those getting married, the decision to stay on their own plan or join their spouse’s plan can impact both coverage and finances, so the couple will need to decide what is most important to them. Having a baby -- even if it is a second or third child -- is the perfect time to take a fresh look at health benefits and overall budget.

  • Get the most mileage. Research and select the plan that is best for employees and their family and manage the plan by being aware of any changes and staying on top of claims and charges. It’s a good idea to keep records in the event of a claim dispute. Copies of medical bills may also be necessary for tax purposes.

  • Ask about extra benefits. Some plans offer discounts on products and services such as dental and vision care, acupuncture, massage therapy, health club memberships and nutritional supplements.

  • Become familiar with brand-name and generic prescriptions. For most people, prescription cost and coverage are at the top of the list when comparing benefits plans. Most health benefits plans that offer prescription drug coverage use a formulary and provide different levels of coverage based on the drug’s cost, efficacy or other considerations (brand-name versus generic, etc). Formularies are also subject to periodic review and changes by a health plan.

  • Consider the convenience of 24-hour hotlines. It’s important for employees to check plan documents to find out what emergency services are covered. Some plans offer an emergency, 24-hour hotline or nurse helpline. The hotline can be helpful to determine if a visit to the emergency room is necessary.

  • Brush up on terminology. What’s the difference between copay, coinsurance, deductible? What exactly is a referral? What does direct access mean? For answers to these questions and other health-care-related terms, employees can view the glossary on the Plan for Your Health site.

No matter what life stage your employees are in, they can make the most of their benefits by discussing the options available to them with their HR or benefits office. For more information on the tips above, refer to www.PlanForYourHealth.com.

BILL BERENSON is vice president of sales and service for Aetna’s North Central Region. Reach him at (312) 928-3323 or berensonw@aetna.com.