How to understand your company’s healthcare plan, so you get the most benefit

Voluntary benefits offered by your employer often appear complicated and can be confusing. Many companies offer several choices for healthcare coverage, and while options are nice to have, they also require the employee to understand the differences between the program offerings. According to a 2017 Liazon study, 83% of employees care a lot about their health coverage but only 52% understand their benefits.  The various nuances of healthcare benefits do not help. Concerns like how and when claims are payable and paid, deductibles, premiums, in and out-of-network situations—the list can go on. The reality is, many people just go with whatever is easiest when it comes to benefits. The selection process often entails an escalating frustration over individual details, followed by selecting whatever option your colleagues are going with.

This less than discerning method negates the whole point of benefit options. Keep in mind, it’s your money and your policies. For your own interests, you need to ask the right questions and understand the commitments—specifically—you are entering into.

To get you started gaining a clear grasp of your healthcare plan and benefits, follow these few tips.

Ask questions

Specific questions to ask regarding health policies include a comparison of the total annual cost of the programs being offered, which would include some assumptions about how often you and your family see specialists, the cost of your family’s prescriptions, and your doctor being in-network. For example, a high deductible program typically carries a lower premium but often requires one to pay out of pocket until the high deductible is reached.  If you and your family are heavy users of healthcare, this may end up costing you more than a lower deductible policy. And conversely, if you are light users of healthcare, your estimated total annual cost may be less.

So, making a decision based on what your desk mate chooses may not be the best choice for you. Your benefits department may be a better resource than the representative from the insurance provider as they are being paid commission based on the number of policies that they are able to write.

Evaluate the pros and cons

It takes some time and attention to decipher the pros and cons of each program offered, but it is worth the investment. Asking questions of the providers themselves, seeking help from your benefits department, and getting together with co-workers to share what you have learned about each program and its fit are the some of the best ways to educate yourself to make an informed decision.

Many insurance products are only available during the open enrollment period, and you will need to stay with your decision for the full calendar year, so make sure it’s the right one for you.

Research the competition

In addition to asking questions about benefits that are offered, it is important to ask your company about benefits that may be offered by other companies and not your employer, specifically.

These voluntary benefit programs typically come at no cost to an employer, and if your leadership knows there is interest, they may be persuaded to add new programs. Financial wellness is emerging as an important benefit offered by many companies today, and having access to financial education programs as well as fair and affordable loans are important tools to build credit and improve one’s focus at work, absenteeism, and company loyalty. The direct connection of financial health with mental and physical health is becoming widely accepted at a rapid pace, and according to a 2020 PwC survey, 40% of financially stressed employees feel that financial issues have affected their health. As a result, many employers are expanding benefit offerings to include financial wellness.

Plan for the future

Now more than ever it is especially important to have a solid foundation of your healthcare benefits and to talk to your employer about options and programs that are of interest. Take the time to sit down, evaluate your choices, ask questions, and communicate about what is worth your time and investment. While healthcare is the first thing that often comes to mind when thinking about employee benefits, there are many pros to financial wellness that companies need to explore and consider for their teams given today’s climate.

Do your research and talk to your employer about the specific options, which can put you and the rest of your colleagues on a better path to mental, physical, and financial stability.

Marion Mathes is the founder and CEO of CreditWorks, a consumer financial benefit company based in Miami. She has over 25 years of leadership experience in the consumer and mortgage credit marketplace, growing and scaling large financial companies.