Open Enrollment: Educating Your Employees on Cost-Effective Ways to Use their Medical Plans

Open enrollment is the one time during the year that employees can make changes to their benefits, but it’s also a time to re-educate them on their plans! Let’s face it- the world of benefits can be very confusing, and it’s important to make sure that your employees understand their plans and most importantly, that they are using them to their advantage! These are a few cost-effective reminders to emphasize during open enrollment.

1. In-Network vs. Out-of-Network Care
   • Have you ever run into a situation where you or an employee received a large bill in the mail that you were not expecting? Has the reason ever been because you went to a doctor that was out-of-network? We see this situation happen quite frequently! Each insurance company has a network of providers that they contract with. If your insurance carrier is not contracted with the provider you see, you would be using your out-of-network benefits if they are available under your plan. If your plan does have out-of-network benefits, it usually comes along with a large deductible and coinsurance. You would be responsible for the full amount of that doctor’s charge, and even after your deductible has been met, you are typically only reimbursed for a percentage of those costs. Most insurance companies have an extensive network of providers to choose from, so it’s important to make sure that you tell employees to double check all of their doctors to make sure that they are in-network with your plan network in order to get the richest benefit available.

2. Urgent Care Vs. Emergency Room for Non-Life Threatening Situations
   • Have you ever waited in the emergency room for what seems like forever for something that is non-life threatening? You are not alone! It seems like most people have experienced this at some point in time. Urgent care centers are a great alternative to using an emergency room for non-life threatening situations. If you check your medical plan, you may see that there is a copay for the emergency room and a separate copay for an urgent care center. Typically, the urgent care copay is less (sometimes by a substantial amount!) than the emergency room copay. Explain to your employees that for minor, non-life threatening situations, urgent care centers can be used as an alternative to the ER. It will more than likely save your employees money in their out of pocket costs and it should definitely save them time.

3. Stress the Importance of Preventive Care
   • The best thing about preventive care is that it is typically 100% covered under the medical plans, so it is no cost for your employees! Preventive care services keep your employees healthy and can help with early detection. Did you know that most insurance carriers have listings of preventive care services broken down by age and gender so you can easily see what you might be eligible for? Visit your insurance carrier’s website to locate their preventive schedule listing and encourage your employees to go for their preventive exams each year.

4. Provide Information on Wellness Discounts
   • When someone thinks of a medical insurance plan, what usually comes to mind? Typically people would respond with things like hospital visits, doctor visits, and prescriptions. Did you know that many insurance companies offer discounts or reimbursements on things like gym memberships, weight loss programs, smoking cessation and nutrition counseling? Encourage your employees to explore all of the discounts and reimbursements that are available to them and use them while they are enrolled.

These are just a few reminders that you may want to reinforce during your next open enrollment to make sure your employees are well-informed healthcare consumers!