Why don’t employees understand their health benefits?

Those who design and manage health care plans may not know just how confusing health insurance can be to the average American. Or, perhaps they do when participants call, complain or otherwise air their confusion to employers and health plan service centers. To choose the best plan option and then be successful in managing their benefits, individuals must understand deductibles, coinsurance, copays, out-of-pocket limits, premiums, health savings accounts and network coverage, among many other factors.

It can be difficult to calculate which plan balances these factors in a way that creates the best deal – especially given the unpredictable nature of our health needs. Simply choosing the lowest-premium plan or the lowest deductible does not make it the best choice for many employees.

For example, whether a care provider is part of a plan's network can have a big impact on health care bills. But according to a poll conducted by the New York Times and the Kaiser Family Foundation, more than two-third of patients who face a bill for out-of-network care report not realizing that the provider was not included within their insurance network.

It takes awareness of personal health costs and matching it to a health plan's cost structure matches personal health needs. Then, successful in covering expenses at the lowest possible level, it takes an educated consumer of medical services. That awareness and education is achieved through trial and error, or through connection to plan resources, service centers, health advocates, tools and plan or employer communications.

If employees do not understand the details of their health insurance options, they cannot get the most from their benefits. Employers need to consider this when communicating their offerings.

That's where we come in. Groh & Associates specializes in helping employers and health plans create short, educational videos on specific resources, services and tools for managing health benefits. Check us out at www.grohcomm.com.

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