10 Health-Care Plan Questions Employers Must Be Prepared to Answer

How to Help Your Employees Choose a Health Care Plan

Your company wouldn’t dream of purchasing manufacturing equipment or technology without full knowledge of how to use it to optimize your business. And with most suppliers, you’ll get answers to any questions before you sign on the dotted line.

As the era of rising health care costs continues, you're asking your employees to pay a greater share for their employee benefits, especially health insurance. So, it’s only natural that they adopt a consumer mindset when it comes to evaluating their benefit options. Your employees are seeking information to be fully informed about their choices: what’s changed, what’s stayed the same, and what it all means for their coverage and costs.

But how do you guide your employees to make the best decision for themselves? One major factor that you should remind your employees to consider is whether they’ve experienced any major life changes in the previous year. Has their health, or that of a family member, changed? Have they experienced a major life event such as getting married or divorced? Has a spouse’s employment status changed? Is there a new baby, or other new dependent in the family? Any one, or a combination of these events might mean they need expanded or different health plan and other benefits coverage.

Equally important are the changes you’ve made. And chances are, you’ve made at least a few.

With employers continuing to make changes to health plans and other benefits to manage costs and improve the employee experience, the result is often more choice and more complexity for employees during the open enrollment period. However, with the right advice, education, and decision support tools from you, making these choices can empower them as health care consumers. And this benefits everyone—you, your employees and the entire health care system.

Open enrollment periods vary by employer but are typically in the fall, beginning in October and ending in December. To help you help your employees prepare, Willis Towers Watson has released following 10 questions employees are likely to ask as they select and enroll in new health plans for 2017.

#1 Has my prescription drug coverage changed?

The Best Practices survey found that employers in all industries, including manufacturing, identified managing prescription drug expenses—especially for specialty drugs—as their top priority.

Among the changes employers plan are issuing new approved drug lists, implementing exclusions, establishing new approval process provisions, and changing pharmacy benefit managers or suppliers.

Any of these actions could mean that an employee’s drugs are no longer covered, must be preapproved, or will cost the employee more money. In addition, employees who use brand-name drugs might find new requirements for generic drug utilization.

Employees who rely on prescription drugs to treat chronic conditions and other illnesses should be encouraged to 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?

Our survey showed that 28% of employers have already reduced the amount they contribute to spousal coverage by adding surcharges for coverage when coverage available through a spouse’s employer.

The percentage of employers adding a working spouse surcharge is expected to nearly double by 2018.

In the manufacturing sector, the average surcharge now is about $100 per month, in addition to required premium contributions.

If an employee has coverage for a working spouse this year, he/she should be advised of the addition, or an increase in the amount, of an existing surcharge.

While less common, employers are also making changes in employee premium contributions to cover dependent children, so employers should be informed of changes here 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 an employee’s preferred doctors and hospitals are no longer in the provider networks you offer.

If employees want to continue with their current providers, they should be advised to confirm which of the plan options available to them their providers accept.

Further, if you have negotiated lower costs with certain providers, employees should be encouraged to consider switching some or all of their providers to lower their out-of-pocket costs.

#4 Have you 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.

In addition, some 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.

Employees should know if you have taken any of these actions for 2017.

In addition, when employees have a choice in plans, they should be advised to consider their actual anticipated needs and avoid over-insuring by purchasing a plan that offers more coverage than they require.

#5 Have you changed administrators for medical benefits?

Another way employers manage costs and keep plans affordable is periodically evaluating, and possibly changing, the third-party administrator of 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 an employee’s costs, but it could mean they have a new telephone number to call or a new process for filing claims or seeking information.

Also, new services might be available that can make the claim and inquiry process easier.

If you plan a change in administrators, make sure your employees are clear on any new services or processing requirements.

#6 Are you offering new or expanded options for receiving care that might be beneficial to me?

Where your employees receive medical services can make a huge difference in their out-of-pocket costs. Today, nearly 64% of employers in the manufacturing sector 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 your employees know which of these types of services are available to them and that they are educated to understand the circumstances under which they would be most beneficial.

#7 Have you 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 an employee’s 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. If you are offering any new voluntary benefits this year, make sure your employees are aware of them.

#8 Does our 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 employees 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. For example, some employers are instituting surcharges for tobacco use, or implementing tobacco-cessation programs to help smokers quit.

In fact, employers in the manufacturing sector are more likely than others to use these to discourage tobacco use and institute surcharges. Make sure your employees understand the different offerings and the terms and conditions of your wellness program.

#9 Have you 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.

Even if employees can afford to pay the full cost of these services themselves, they should know whether their health plan or you, through other types of coverage, will reimburse them for some or all of the costs they incur.

#10 Have you added or expanded the use of technology for delivering and managing my benefits?

Technology-based solutions to help employees evaluate, select, enroll in and manage 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.

If you’ve adopted a private benefits exchange or other technology support for your employees, inform and educate them on their advantages and uses, and how they can best take full advantage of them while selecting and enrolling in benefits.