Employees are befuddled by their health care coverage. This is nothing new. But at the height of a pandemic, it's all the more troubling.
Only about one-third of employees (34 percent) have a solid understanding of their coverage options, while 15 percent have a "somewhat" or very low level of understanding. That's the estimate of 461 benefits managers across the U.S. polled by the International Foundation of Employee Benefit Plans over the summer.
"Employers are aware and frustrated by it," said Dr. Arthur Leibowitz, chief medical officer and founder of Health Advocate, a provider of benefits programs based in Plymouth Meeting, Pa. Employees "don't pay attention to benefits until they need them or run up against a problem with them."
With so many employees working at home due to COVID-19, there are additional challenges now. "The virtual workforce has been thrown for a loop with no in-person [information] sessions," said Anna Phalen, vice president for sales and account management at Jellyvision, a benefits enrollment technology firm based in Chicago. Some employers have had to introduce mobile apps for employees who don't have computers at home.
Employees also are paying more attention to health benefits during the pandemic and are more worried about costs, Phalen said. They have new questions about benefits such as telemedicine coverage and whether curbside testing for the coronavirus counts as "in-network" care under their health plans.
Changes in Plan Coverage
As always, benefits coverage is likely to change in comparison with last year, even if the plans offered to employees remain essentially the same, said Alison Caballero, director of the Center for Health Literacy at the University of Arkansas for Medical Sciences (UAMS), in Little Rock. Regulatory changes "will affect some employees, along with what preventive services their policy covers," she noted.
For instance, as part of the Coronavirus Aid, Relief and Economic Security (CARES) Act, signed into law in March:
- Account holders can now use health savings accounts (HSAs), health reimbursement arrangements (HRAs) or health flexible spending accounts (FSAs) to pay for over-the-counter medications without a prescription. The act also allows account holders to use their HSAs, HRAs and FSAs to pay for certain menstrual care products, such as tampons and pads, as eligible medical expenses. Thought the act was a response to the coronavirus, these changes are permanent.
- High-deductible health plans can cover telehealth remote care services before participants have met their deductibles without affecting their eligibility to make HSA contributions through Dec. 31, 2021, unless Congress extends this provision or makes it permanent.
Leave the Driving to AI?
Employees spend relatively little time enrolling in their benefits—18 minutes, on average, one study found, and 30 minutes or less, according to another—and they tend to wait until the end of the enrollment period when there is little time to examine plans carefully. Ultimately, many default to last year's plan without reviewing new options.
Given the challenges of communicating about health care benefits, the marketplace is overflowing with benefits selection and enrollment software platforms, benefits-spending calculator tools, and consultants adept at engaging employees with short attention spans.
Vendors of artificial intelligence (AI) decision-support tools, which can be embedded within benefits enrollment platforms, have products to help employees make better decisions when selecting health benefits. These tools offer a plan recommendation based on employees' online answers to questions about their health status, how often they see a doctor, family size, projected prescription spending and tolerance for out-of-pocket costs.
Employees are not bound to accept AI recommendations, stressed Phalen, whose firm markets the AI-driven ALEX benefits-navigation platform. The purpose of the tool is to help employees better assess how their needs align with selected plan benefits. "If a high-deductible plan is the best option, it will help the employee understand HSAs and tax savings to make the most of it," she noted. Nitty-gritty questions about benefits still go to the HR team.
Health Advocate's tool, Enrollment Advocate, walks employees through benefits selection with a combination of app, online service and phone assistance. The value of this approach is having access to a person who can explain the benefits structure so HR managers don't have to take the calls in-house, Leibowitz said.
According to the nonprofit Employee Benefit Research Institute (EBRI), nearly one-third of employees would like their employers to provide online benefits-selection and decision-support tools, a July/August EBRI survey of more than 1,000 U.S. workers showed.
When EBRI asked, "They next time your company has open enrollment, how would you like them to communicate and provide information to you," employees' responses included:
- An online portal for selecting benefits (36 percent of respondents).
- An online tool that helps you make decisions about your benefits (35 percent).
Questions to Ask Vendors
Benefits specialists advise asking these questions when comparing benefits software tools:
- Is employee confidentiality and information privacy ensured?
- Is the presentation jargon-free? Are all terms defined?
- Is it intuitive and well-organized, and can employees easily to find what they need?
- Does the platform allow customization or add-ons if needed?
- Is the product engaging with visuals, graphs, charts and interactive features?
- Are all needed benefits on the platform, or will multiple vendors be required?
- What days and hours is the service accessible for use?
- What is HR's role in the process?
[SHRM members-only toolkit: Leveraging the Value of Employee Self-Service Portals]
The Multilayer Approach
A dedicated intranet portal or benefits website should feature a summary of plan options, necessary forms, contact information, FAQs, a glossary of terms, explanations about HSAs and FSAs, resource links, and a calendar for enrollment dates or information sessions.
Phalen recommends that employers use every channel available—"the more the better"—to communicate benefits information. She advises using a multilayer approach in which the same message is conveyed in a different format to accommodate all preferences: e-mails, webinars, postcards, fliers, videos, social media, mobile apps, meetings and workshops, and text messages. Benefits information and updates should be distributed year-round, not just before open enrollment or during onboarding.
All benefits communication should use "living-room language," said Alison Caballero, director of the Center for Health Literacy at the University of Arkansas for Medical Sciences, in Little Rock. "This is a tall order that goes beyond writing at a lower reading level." For example, "say 'use' instead of 'utilize' and 'start' instead of 'commence,' " she explained. The university's Center for Health Literacy markets a Plain Pages service for employers who want a professional editor to review their materials and provide a Spanish translation, if requested.
Pay special attention to numbers in your presentations that tend to confound health care decisions, Caballero advised. In a survey by the nonprofit Kaiser Family Foundation, barely half of employees could calculate the amount they would have to pay out of pocket in a scenario involving deductibles and co-pays.
"Make the math simple," Caballero recommended. "Use whole numbers rather than percentages, fractions or decimals" when feasible.
A final best practice: Survey employees about the process after your benefits enrollment concludes, experts suggest. That will put you ahead for making improvements next year.
Expanded Health Offerings for 2021
During open enrollment this fall, "many of the enhanced benefits employees can expect to see are in areas that employers had already been investing in, and the pandemic has accelerated, including greater access to virtual care options and mental health services," said Ellen Kelsay, CEO of the nonprofit Business Group on Health, which represents large employer.
Results from the group's 2021 Large Employers' Health Care Strategy and Plan Design Survey, conducted over the summer with responses from 122 large employers, showed that next year:
- 53 percent of large employers will offer more virtual care options. Most employers offer telehealth for minor, acute care and mental health, and many are extending virtual options to weight management, care management for chronic conditions such as diabetes and cardiovascular disease, prenatal care, and musculoskeletal care management/physical therapy.
- 88 percent expect to provide access to online mental health support resources, such as apps, videos and webinars, up from 69 percent this year. More employers also plan to train managers to recognize mental health issues and direct employees to appropriate services.
Employers have been adding more Centers of Excellence (CoE) options to their benefit packages for the past several years to encourage employees to receive treatment at selected hospitals known for high-quality specialty care. Eighty-one percent of large employers will have at least one condition-specific CoE in place next year.
Eve Glicksman is a freelance writer based in Silver Spring, Md.
Related SHRM Articles:
A New Role for Critical-Illness Insurance in the Coronavirus Era, SHRM Online, September 2020
Spotlight Value of Benefits Package During Open Enrollment, SHRM Online, August 2020
Does AI Have a Place in Open Enrollment?, SHRM Online, September 2019
Data-Driven Benefit-Selection Tools Are Just Getting Started, SHRM Online, September 2019
Related SHRM Resources:
Open Enrollment Guide & Resources
Vendor Directory: Benefits Enrollment and Admin
[Visit SHRM's resource page on Open Enrollment.]