Online enrollment platforms are great, but communication and understanding are terribly important for the end-user.

I always say, “technology is great, when it works.” Online enrollment platforms have been around for years, and the technology that powers them has grown and advanced at an exponential rate. Who would have guessed that we would be enrolling in our employee benefits directly from our own phones and tablets, without being given the huge enrollment packets from HR?

In this virtual communication age, you can’t take the “human” out of Human Resources, and you can’t take the confusion out of insurance benefits just because you wrap it in a nice, pretty website with fancy graphics and videos.

An employee’s health concerns and needs are as diverse and different as hair colors are at Comic Con, so while a brief overview of plan details is fine for one person, someone else wants to know how many physical therapy visits they can have in a year, or if their child’s insulin pump will be covered on their plan.

A simple online enrollment platform does not always meet the needs of all employees, and not all platforms will offer the level of detail some will require. Aside from posting the evidence of coverage, or insurance contract, at a place that is easily found on the portal, there may not be a way to achieve that level of detail. However, even for those that don’t need that level of detail, critical information must be communicated easily and effectively.

Costly mistakes can be made when benefits are not communicated effectively, or when important information is simply omitted. For example, since the Patient Protection and Affordable Care Act (ACA) was implemented, some employers have opted to offer minimum value plans (MVPs), or plans that cover very few procedures such as office visits, preventive care, and hospital room and board, but they do not cover a wide range of other services such as ambulance, surgery, medical devices, physical or occupational therapy, etc.

When an employee sees a number of choices or plans from which to choose, they will likely compare the various plan options by looking at the carrier, if the plans are HMOs or PPOs, and the cost. From there, an employee may look at the office copays, deductibles, prescription drug costs, and coinsurance.

If the comparison shows MVP plans as well as traditional health plans, but does not call out in big, bold letters, all of the items the MVP plan does not cover, one could come away with the understanding that if they choose the MVP plan, they are selecting a plan that is a comprehensive insurance plan just like the other plans shown, or like they have had in the past.

Most of us don’t read our car insurance policy in detail until we get in an accident and the insurance adjustor says, “sorry, your policy does not cover that.” The same is usually true for our health insurance plans.

You could argue that it is the responsibility of the employee to verify that the plan they are choosing meets all of their needs, certainly. But if that information is not easy to locate, you could find fault with the employer, or insurance carrier, if there were to be a problem. Furthermore, an employer would want to show their employees that they want to take care of them, and not set them up for failure in the event of a crisis.

Let’s walk through a scenario. An employee named “Joe” is 28, and is enrolling in his company’s health plans during open enrollment. His company recently merged with another larger company, and so the benefits being offered are slightly different, but look pretty close to what they had been last year. There are four plans offered, two that are HMO plans with Kaiser and two that are PPO plans, one is labeled Silver, the other Gold.

Joe is young and single, and when he was living at home with his parents, he had never had Kaiser and always traditionally had PPO coverage. Last year, Joe enrolled in the Silver PPO plan so he could continue to see the doctors that had been managing his care for all of his adult life, so he elects the same plan this year. The online system shows a $250 deductible, $40 office visit copay, and 30% coinsurance. In addition, the Kaiser premiums have gone up considerably from what he remembered them to be last year, and are higher than the PPO plan options, so he feels comfortable that he has made the choice that is best for him.

Later in the year, he comes down with a bad cold. The pressure in his head that is caused by the cold is so severe that when he sneezed, he blew out his right ear drum. He goes to the doctor, and his doctor orders a CT scan of his ear. The CT scan shows he has perforated his ear drum and will need surgery to repair it. The surgery is scheduled for two weeks after that. He contacts the hospital and surgeon to confirm they are contracted, in-network providers under his health plan, and asks them to do a pre-determination of benefits so he will know up front how much he should expect to pay as his 30% of the cost of the procedure.

While waiting for the surgeon and hospital to get back to him regarding the out-of-pocket costs, he receives the bill for the CT scan and explanation of benefits from his doctor for the office visit and CT scan. They show his office copayment that he paid at the time of service, and his $250 deductible, plus 30% of the remaining cost of the CT scan, which came out to a total of $500. He pays the bills and continues to work even though he is in extreme discomfort from his right ear.

The surgeon and hospital both get back to him and let him know the surgery itself will cost approximately $20,000 because his plan does not cover surgery, period. Joe is not an executive in a large company; he does not have the money to pay for a $20,000 surgery and also afford to take three weeks off of work in order for him to recover. So, what is he to do?

He can’t enroll in another plan offered by his employer for another nine months when they go through open enrollment again. It is March, so he has missed the state Exchange open enrollment window, and he has not experienced an involuntary loss of coverage that would enable him to enroll in a state Exchange plan. If he were to purchase a short-term, comprehensive medical plan it won’t cover any pre-existing conditions, which his perforated ear drum would certainly be considered. So, unless he gets married and enrolls on his new spouse’s plan if they were offered one by their employer, he is out of options. He will simply have to wait until open enrollment next year.

How do you think Joe is feeling about his employer right now? Do you think he is counting his blessings that he only ruptured his ear drum and was not diagnosed with cancer that needed to be removed before it spread any further? Or is he going to be using a few choice words to describe an employer that offers a medical plan to its employees that has a longer list of services not covered than are covered? I can’t say that I know for sure, but I can guess.

Now, the question becomes how does an employer prevent their employees from running into these kinds of pitfalls? It comes down to clear communication—multiple forms of communication that are easily accessible to employees and their family members that may also play a role in making plan decisions. Having someone to partner with your company, such as a UBA Partner Firm that will not only help you develop long-term plan strategies for your employee benefits package, but can be an integral part of developing and implementing online systems, hard copy communications, and give you access to tools such as smartphone applications that not only give employees access to essential information, but also push out important communications that contain relevant information at the appropriate times like open enrollment. Making plan details easily accessible in the online platform, with clear and bold statements if there are essential benefits that are not covered on the plan such as a warning, should be clearly stated so that employees are well informed.

An ounce of prevention is worth a pound of cure. Insurance is a complicated business and you, as an employer, would not want to make decisions about the health care you offer your employees without someone to guide you through the various options and possibilities. As responsible employers, our employees should not have to either.

By Elizabeth Kay
Originally Published By United Benefit Advisors

Switching over to AEIS Advisors was the best decision we’ve made this year. Ronald and his team were able to identify discrepancies on our billing statements which got missed by our last broker, and they saved us over $8,000 in credits! AEIS has proven to be an attentive and caring company, looking out for the best needs of their clients."

- Director of Operations

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