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Your employees depend on their healthcare coverage for themselves and for their families. At the same time, employers trust that their health plan administrator takes care of their employees while managing spend. But recently, you’ve heard more complaints from employees about gaps in service and concerns about coverage. Suddenly, what was intended to be a competitive benefit to keep your workforce strong is presenting symptoms of a broken system.
You’re not alone. A spate of recent insurance carrier mergers has resulted in fewer entities providing care and larger numbers that these mega-companies are responsible for covering. With larger numbers of employees relying on the limited resources of large insurance carriers, it might come as no surprise that basic service issues are becoming the norm and individual answers from knowledgeable benefits professionals are the rare exception.
If your HR department is hearing the following questions from employees, a lack of service from your health plan administrator may be to blame.
For most employees, their involvement in healthcare benefits stops after selecting a plan during open enrollment. Research backs up this claim, with a recent Harris poll finding that although they may have been involved in electing their plan, two in five insured Americans did not have a good understanding of the services actually covered under those healthcare plans.
When employees need care, avoiding the ins and outs of their health plan benefits are no longer an option. Your health plan administrator should be your partner in clearing the lines of communication and helping educate employees about their benefits.
It's a process that starts with a comprehensive overview of the benefits your company offers, often given to employees as part of a handbook or online document. A successful program includes an engaging Open Enrollment process that carefully walks employees through choices and continues with hands-on customer services and online tools.
Need a place to start? Share our guide to employee benefits with your team.
Employees are becoming increasingly engaged in cost of care discussions, with 17% of Americans reporting that healthcare is their family's top financial concern. What many employers and employees don't know is that in the face of rising premiums and network discounts there are significant opportunities for cost savings within their network.
For example, prices for common imaging and surgeries can vary by thousands of dollars between facilities within the same ZIP code. That means an employee in need of a knee surgery can pay as little as $2,000 or over $18,000 for the same procedure. With the employer footing the bulk of the bill, both parties stand to overpay by up to 500% if options aren't carefully explored.
On the other hand, proactive utilization management can save employees and employers money. In some cases, employers are even incentivizing employees with monetary rewards to explore their options.
Related: Six ways to help employees manage rising healthcare costs.
Employees should never question that they are getting the right care, at the right place, for the right price.
Unfortunately, it's much easier said than done. Shareholder obligations, mergers and a lack of independence can obstruct an insurance carrier's ability to act on behalf of your financial investment and your employees' health. An independent administrator with the ability to contract directly with facilities who provide the best care at a fair price presents a win-win for employers.
Members, providers, employers and payers should all be communicating about patients and treatments to deliver a seamless and cost-effective experience. In afact, a recent study conducted by J.D. Power & Associates found that health plans that utilize an integrated delivery system outperform traditional health plans in every one of the following factors: coverage and benefits; provider network; communication; claims processing; premiums; and customer service.
Unfortunately, this doesn’t always happen, costing HR precious time and leaving members to navigate the healthcare system on their own.
Employers are increasingly turning to concierge member service models that provide one-on-one customer service from a live medical expert. Typically, these services provide employees with guidance on finding fair-price treatment options and resolving billing issues. It's this level of personalized service that reduces burden on HR and truly engages employees in their health benefits.
See it in action: Hear from one member who saved herself and her plan over $20,000
All of these questions beg the question: Can large carriers provide a healthcare experience that takes care of your employees and your bottom line?
To see how an active approach to health plan management could help your organization, contact us here.
AUDIT YOUR HEALTH PLAN
The Thrive blog team is made up of health journalists, health coaches, Advisors and other experts who take what we know and turn it into helpful guide for you, our members. Have a question for one of our Health Coaches to tackle? Tweet it to us at @healthgram.
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Healthgram partners with self-funded employers, benefits advisors, hospital systems and other organizations to deliver a better healthcare experience.
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