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10 Questions for Employees Choosing a Health Plan

Encourage employees to consider any health and relationship changes before making their open enrollment selections

A man and woman are sitting at a desk looking at a laptop.

To help employees gain insights about their benefits during the upcoming open enrollment season, ask them to consider major health and relationship changes before making their selections.

Affordability of health plan premiums and costs will remain a concern, said Randall Abbott, health care leader for Willis Towers Watson in Boston. "Employees can expect to see changes in the cost of spouse and dependent coverage, especially if the spouse is working and has access to his or her own employer-provided health coverage. They can also expect employers to encourage use of treatment settings and service providers that deliver higher-quality health care at lower cost," he said.

Open Enrollment Season

For tips on helping employees make the best choices of benefits during open enrollment, check out the SHRM resources provided below:

· Guide to Open Enrollment
· Health Benefits Glossary of Terms 
· Explaining High Deductible Plans to Employees

Abbott recommended that employees ask the following 10 questions of their employers to help uncover any plan changes and select the coverage options that best meet their needs.

1: Has the employer's prescription drug coverage changed?

Nearly 9 in 10 employers identified managing prescription drug expenses—especially for specialty drugs—as their top priority, according to the 2016 Willis Towers Watson Best Practices in Health Care Employer Survey, completed by 600 U.S. employers between June and July. Advise employees to:

  • Find out if your employer has put in new approved drug lists, implemented exclusions or established new approval process provisions that might mean your drugs are no longer covered, must be preapproved or will cost you more money. A change in pharmacy benefit managers, or suppliers, might also trigger changes.

  • Consider switching to a generic or lower-cost alternative where available.

2: What is the status of health coverage for my working spouse or children?

The survey showed that 28 percent of employers have reduced the amount they contribute to spousal coverage by adding surcharges for coverage when it is available through a spouse's employer. The percentage of employers adding a working spouse surcharge is expected to nearly double by 2018. The average surcharge is about $100 per month in addition to required premium contributions.

*If you have coverage for a working spouse this year, find out if your employer is adding or increasing the amount of an existing surcharge.

  • While less common, employers are also making changes in employee premium contributions to cover dependent children, so ask about that as well.

3: Are my preferred doctors and other medical service providers still covered?

Some employers change health insurance companies, plans or provider networks to better manage costs. This can mean that employees' preferred doctors and hospitals are no longer in the provider networks available to them.

  • Find out which of your new plan options accept your current health care providers.

  • If your employer has negotiated lower costs with certain providers, consider switching some or all of your providers to lower your own costs.

4: Has the employer taken steps to make health care costs more affordable for me?

Concerned about affordability of health care costs, some employers have made changes specifically designed to lower out-of-pocket costs at the point of service or have lowered premium contributions for low-wage workers. Other employers now offer account-based health plans with tax-advantaged health savings accounts associated with them and have seeded the account to help employees cover increased out-of-pocket costs.

  • Find out if this is a new action your employer has taken this year.

  • When you have a choice in plans, consider your real needs and avoid over-insuring by purchasing a plan that offers more coverage than you need to meet your likely needs.

5: Has the employer changed administrators for medical benefits?

One way employers can manage costs and keep plans affordable is to periodically evaluate the health plan that administers the medical benefits they offer. These third parties administer claims and provide the other services associated with the medical benefit program. A new administrator might not affect employees' costs, but it could mean they have a new telephone number to call or a new process to follow for filing claims or seeking information. Also, new services may be available that can make the claim and inquiry process easier.

  • If you see a change in administrators, make sure you are clear on any new services or processing requirements.

6: Is the employer offering new or expanded options for receiving care that might be beneficial to me?

Where employees receive medical services can make a huge difference in their out-of-pocket costs. Today, nearly 64 percent of employers offer telemedicine consultations with doctors or other care providers when appropriate, which are considerably less expensive than in-person doctor's office, urgent care clinic or emergency room visits. In addition, a growing number of employers are contracting with centers of excellence that have proven to deliver better results and higher-quality outcomes for back, knee, cardiac, infertility and other issues. Employers often offer employees incentives for using centers of excellence.

  • Make sure that you know which of these types of services are available to you and that you understand the circumstances under which they would be most beneficial.

7: Has the employer added new or expanded voluntary benefits I might find valuable?

Voluntary benefits are gaining traction with employers interested in meeting the needs of a more diverse, often multigenerational workforce. They have the benefit of being relatively low cost for both employees and employers. Depending on employees' needs, conventional voluntary benefits such as dental, vision, life and disability insurance might make sense for them. Emerging benefits such as student loan refinancing programs, identity theft protection or even pet insurance might also be attractive.

  • Find out if your employer is offering any new voluntary benefits this year.

8: Does the employer's wellness plan have new features that can help me manage my health or save me money?

Some employers are adding capabilities to wellness programs such as lifestyle coaching or fitness wearables available at low or no cost for tracking exercise activities or nutritional intake. Plus, there are now mobile apps connected to wellness platforms that can automatically send recommendations or reminders to prevent or manage existing health conditions. Many employers also offer financial incentives for taking advantage of these capabilities as well as other health improvement activities. Some are instituting surcharges for tobacco use or implementing tobacco-cessation programs to help smokers quit.

  • Make sure you understand the different offerings, and the terms and conditions of your employer's wellness program. Don't leave money on the table.

9: Has the employer added or expanded coverage for complementary or alternative medical services?

Even though complementary and alternative health services such as physical therapy, chiropractic, acupuncture and massage have become commonplace, many health plans offer minimal, if any, coverage for these services.

  • Find out whether your health plan or your employer through other types of coverage will reimburse you for some or all of the costs you incur, even if you can afford to pay the full cost of these services yourself.

10: Has the employer added or expanded the use of technology for delivering and managing my benefits?

Technology-based solutions to help you evaluate, select, enroll in and manage your employee benefits are growing in popularity—from private benefit exchanges with decision support tools such as out-of-pocket cost calculators and recommendation engines that offer a consumer-like shopping experience, to web-based enrollment portals and mobile apps.

  • Make sure you know what your employer has already put in place or is considering so you can take full advantage of your power as a health care consumer.

SHRM Resource Page:

Guide to Open Enrollment


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