Health Insurance: Programs Aren’t That Complicated…or are They?

Some people cringe at the sound of screeching. Others, at the sight of blood. Some, at the thought of health insurance.

While employer-sponsored benefits may seem pretty straightforward to industry experts, employees and family members may not agree. Listed below are some tips to consider when cultivating a culture of understanding among your employees and their family members.

• Extinguish HMO myths. The HMO vs. PPO battle has simmered over the years, driven by price points and HMO improvements. While HMO networks continue to be slightly lower than the PPO cousin, the majority of major hospitals and doctors are HMO contracted providers. Provide your staff with the tools to lookup providers, and be sure they elect a primary care physician (PCP) during open enrollment. Failing to do so could cause issues when setting a doctor’s appointment.
• Describe sister networks. If you have employees nationwide, then it’s crucial to leverage various networks in order to accommodate insurance needs. Carriers fill voids in network gaps by leasing networks to gain area access. While this sounds awesome, avoid confusion by providing your employees with a breakdown of each network, and give them the billing phone numbers. Their doctor offices will need to know which networks to bill, and this information is listed right on the ID card.
• Properly explain account-based programs. Account-based plans are a thing of today. High deductible plans may be offered as a stand-alone program or packaged alongside a healthcare account that possesses funds accessible by an employee for medical, dental, and/or vision costs. The accounts vary, based on employer/employee funding, ownership, deposit caps, annual rollover terms, and eligible expenses. The tax advantages seem to benefit the majority of consumers and bring value to the benefits package. Using visuals to clearly identify the order of payment, eligible expenses, and usage restrictions will help solidify understanding and appreciation.

For additional tips, work with your agent partners. They may have access to a library of written documents and/or videos that will aid in the insurance planning and communication phase.