ARLINGTON, VA, February 18, 2015 — An analysis of the top 10 questions asked by full-time active employees who enrolled in health plans effective January 1, 2015, on Towers Watson’s OneExchange shows that when offered a meaningful choice of health plans on private exchanges, first-time enrollees need basic information about their plan choices and how health insurance works. This underscores the importance of employers and exchange providers offering education, decision support tools and personalized, expert advice to help employees choose the plans that are best for them and their families.
Here are the top 10 questions employees asked, with implications for employers and employees alike, going forward:
1. Which plan has the lowest cost?
Using premium cost as the most important criterion for making health plan choices could be a mistake, because the least expensive plan is not always the best one for a given individual. Other factors that should be taken into consideration include employees’ health status, the doctors and hospitals they use, and the prescription medications they take.
2. What are the copays for the medical plans being offered?
Historically, employees have gravitated toward the predictability of preferred provider organization (PPO) health plans with copays, but they may not understand that these plans may cost more out of pocket and may not be the best plan choice for them. Some employees may be surprised to learn their employer doesn’t offer any copay plans. In these situations, it’s important to explain that there may be plans of similar value even if they have different coverage features.
3. Why do my health plan options have high deductibles?
As employers seek ways to keep health care costs down, many are offering only account-based health plans, which are consumer-driven plans that have high deductibles and are connected to accounts for funding or saving for health costs, such as health reimbursement arrangements (HRAs) or health savings accounts (HSAs). Employees need tools to help them understand how these plans may actually be the better choice for them. Employees also need help understanding how accounts work and the tax advantages of HSAs. Some employers enhance this transition by jump-starting the balance with a cash contribution, or “seeding the account.”
4. What's the difference between gold, silver, bronze and safety net plans?
The metal tiers mandated by the Patient Protection and Affordable Care Act (PPACA) for public exchanges (and adopted by many private exchanges) are designed to make it easier for people to compare plans. However, employees should delve deeper into the details beyond the metal hierarchy. Coverage, premiums and out-of-pocket costs vary by plan and insurer within the metal plans. Employees should make decisions based on a thorough comparison of plan details, and they often need the help of decision support tools and live, personalized advice from an expert to do that.
5. What do I need to do to earn my wellness dollars?
Over 50% of enrollees say they will engage in wellness activities and have many questions on how to earn wellness dollars, when they’ll have the money in their account and what they can spend it on. This is good news for employers, which in the past have struggled to engage employees in wellness programs.
6. How do I know if my doctors are part of the plan I choose?
Being able to continue seeing their current medical providers is top of mind for employees when evaluating new health plans. However, answering this question can be a moving target as contracts between doctors, hospitals and insurance companies can change from year to year. Exchange providers can make this complicated task easier by integrating doctor and facility lookup tools into the exchange enrollment experience. Many physicians are part of multiple plans, giving employees the choice of carriers and price points while still keeping their family physician.
7. What’s the difference between an HRA, HSA and FSA?
Health insurance is a complex topic with confusing jargon and acronyms. HRA, HSA and FSA (flexible spending account) refer to the options employers have for funding health benefits through accounts that offer tax advantages to employees and employers for offsetting health care costs. These types of accounts have been available for some time, but are increasing in popularity as employers seek new ways to fund health benefits and encourage employees to save for health expenses.
8. What does the prescription drug plan cover?
Employees are confused by the array of pharmacy provisions, copays, coinsurance minimums and maximums, formularies and more. They want specific information on what their drugs will cost for each of the plan and insurer options they have to choose from. In addition to using the decision support tools available, many employees want to talk to an informed service center representative about their particular circumstances.
9. What are the differences between insurers?
Confronted with different price points from different insurers for similar plan designs, employees want to know what added value they might be getting from a higher-cost insurer. While most insurers believe they do a good job of marketing and differentiating themselves from the competition, the prevalence of this question suggests there is more work to be done.
10. If I want to keep the same plan I had last year, do I need to do anything?
Historically, plans have had default rules that place employees in a predetermined safe plan choice if they don’t take action during open enrollment. In an exchange offering, some employers want to encourage an active enrollment choice each year so employees get to know the available options through a shopping experience. As employers offer more voluntary and ancillary benefits, employees should evaluate annually which of these to keep or change, as well.
“Providers of private exchanges and employers using them have an obligation to help employees understand their health plan choices as fully as possible,” said Jean Moore, a managing director of Towers Watson who oversees OneExchange for full-time active employees. “Education prior to enrolling is key, as well as having integrated decision support tools and personalized guidance from trained benefit advisors during the process. Employees’ top questions show a desire to become informed consumers before making a decision as important as health coverage. When moving to a private exchange, the success and satisfaction employees experience with their health benefits depends on their employers’ efforts and the effectiveness of the exchange’s products, consumer experience and service center.”
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