Apr 19, 2016

Do You and Your Employees Understand Your Health Insurance Benefits?

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One major challenge facing employers and other health plan sponsors is helping consumers to understand their health insurance, and other employee benefits. In the past, we have discussed the importance of educating employees about their benefits and how to help employees use them towards better health and productivity in their daily lives.

As a result of the challenges involved in understanding and using health insurance, many Americans learn how to use their plans by trial and error, often racking up large bills because they don’t understand how the health care system works. Premiums or other bills may not be paid on time, preventive check-ups are not scheduled, and trips to the emergency room are often made when a visit to urgent care or a call to a primary care provider would have sufficed — and been less costly. This also costs employers lots of money in medical bills, absenteeism, and much more.

One major key to managing health care costs, is where to seek appropriate care. If consumers need timely care, but do not have an emergency, they should avoid using the ER. Without clearly understanding their coverage plan, consumers may not recognize that ERs are a significantly more expensive route for health care. They will be left to foot a larger portion of a more expensive bill than had they sought help through urgent care, a same-day appointment with their own doctor, or even by calling a 24-hour nurse hotline provided by their insurance carrier.

There are a few alternatives to the ER that may be less well-known to those learning to navigate their coverage.

  1. Patients can call their doctor's office at any time to receive medical advice. Many doctor offices forward queries to call service centers that will take messages and have a health care professional return the call, even after standard business hours. This person may offer advice on how to treat a condition, call in a prescription to a pharmacy or instruct the patient to go the emergency room.
  2. Another option for patients is going to a walk-in urgent care clinic covered by their plan. Often offering extended hours, these clinics are significantly cheaper than going to an ER. Consumers enrolling with a new insurance company should be sure to find out before an emergency which urgent care clinics their plans cover.

Two additional aspects of health insurance can have financial repercussions when consumers don't understand how they work: networks and which services are free (meaning they are included in their health plans at no additional charge).

For consumers who previously did not have an insurance plan that limited their choice of doctors, the concept of staying within a provider network may be unfamiliar. It's best for patients to call the insurance company prior to an appointment with a new doctor or specialist to make sure he or she is in its network. If that doctor is not in the network, the company should provide names and phone numbers of those who are, and the patient should cancel the appointment to avoid paying for it.

The Affordable Care Act established that all health insurance plans now come with free preventive services that include an annual checkup and tests that depend on age and gender. Patients are not charged additional fees for these services. All insurance plans also now include services such as drug and alcohol counseling, obesity testing and counseling, help to quit smoking, breastfeeding support and birth control (excepting plans sponsored by exempt employers affiliated with religious organizations). Patients should ask their insurance companies which tests are included in their plans and which are right for them.

AWANE provides comprehensive benefit offerings to address almost any issue related to health and overall well-being of our members and their employees. For example, our wellness rewards program provides cash incentives to individuals for healthy actions such as annual checkups, mammograms, and much more. Another program designed to provide support for other issues such as substance abuse, financial stress, and other issues falling outside the scope of health insurance is our Employee Assistance Program. We strongly believe in regular communication about our benefit offerings so that employees are fully aware of the programs available to them, and utilize our programs accordingly.

We exist for the health of our member groups and to provide best in class service, support, and programs that grow each year, while many others are doing the opposite. We encourage you to learn more about our programs and to contact us and find out how we can help your business be more successful.

Since 1929 we have helped hundreds of businesses grow and stay strong during uncertain times. Our 99% retention rate speaks for itself!