During open enrollment, employees usually familiarize themselves with their coverage. But just a few months later, much is forgotten.
An effective communications plan can also help employees avoid these five common health insurance mistakes:
#1 Underutilizing Health Savings Accounts (HSAs)
Employees are easily confused by HSAs. They may not know which expenses are eligible for reimbursement, or they don’t realize they can contribute funds at any time.
To help, point employees to the IRS list of eligible expenses from acupuncture to X-rays.
Next, educate employees about their ability to add extra cash to the HSA anytime throughout the year. For example, after a root canal or a trip to the emergency room, employees can deposit money to pay their out-of-pocket costs.
#2 Paying too much for prescriptions
Everyone loves to save money, and understanding prescription coverage can help. If your plan has a mail-order option or a preferred pharmacy, be sure employees know about these economical alternatives.
Also, publicize information about your carrier’s online drug formulary to help employees choose less expensive options when available. One caveat: Online formularies aren’t always up-to-date. When in doubt, employees should call their insurer’s member service department for clarification.
#3 Understanding preventive care
Knowledge is power. Most health plans provide preventive care like routine physical exams, immunizations and screenings at no charge. But confusion about what’s preventive and what’s not can cause angst.There are two key issues:
To clear up confusion, provide employees with a link to your insurer’s preventive care guidelines, which outlines no-cost services based on age and gender. Each insurance carrier provides a list of preventive care services - a sample can be accessed here.
#4 Getting unexpected out-of-network billsIf your company benefits plan includes an HMO, it’s essential that employees understand how claims will be processed:
Even employees with a PPO may have surprises. Although PPO plans cover a predetermined percentage of the cost, this payment is based on “reasonable and customary” charges. This could leave employees paying more than anticipated. Read Consumer Reports “The $20,000 Tick Bite” for a dramatic example.
#5 Ignoring EOBs
Some employees make the mistake of paying a provider’s bill before reviewing their explanation of benefits (EOB). When that happens, they may inadvertently pay too much.
How to help? Remind employees to take a wait-and-see approach with medical bills. Once the EOB arrives, they can compare it with their provider invoices to be sure the information aligns.
The good news? Many insurers have redesigned and even renamed their EOBs to make the information easier to understand. Insurers also provide online member access, so employees can log into their accounts and review claim details online.
Contact your BDR service team for more guidance on helping employees maximize their benefits.
Good news! You may be eligible for a subsidy through Covered California, the state of California's Health Benefit Exchange. Navigating Covered California can be tricky and time-consuming, and we're here to help if you need it.
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