Open Enrollment is Just Around the Corner: Make it Not So Scary
Is it any coincidence that one of the scariest times in HR occurs around Halloween? For months, the dread of Open Enrollment often haunts Benefits Administrators and HR Professionals who struggle to keep their heads above water during this turbulent time. Many report a sense of helplessness being at the mercy of insurance providers when it comes to premium hikes followed by an urgent rush to roll out the offerings often marred by a lack of time and information to help them adequately prepare to educate their company’s employees on one of the most critical and complex decisions they make for themselves and their families. The Open Enrollment period experience itself and subsequent costs incurred and quality of care received by employees after they make their coverage decisions can play a vital role in overall employee satisfaction and retention. So how can you make improvements this year to be better prepared, make it easier on you and your employees and make future Open Enrollments not so scary, while potentially also seeing some savings in the future?
Give Employees the Right Tools
Cost of coverage can be a deciding factor for many families when trying to determine the coverage type and tier that they will select. Those who live paycheck-to-paycheck may feel they are limited to the lowest levels of coverage. Often employees forget or have a hard time guesstimating what their take-home pay will be once they have made their pre-tax elections. You can help them get a better idea of costs and also remind them of the importance of conducting periodic payroll checkups to ensure they are choosing the right withholding amounts, etc. Provide employees with a few resources to give them a better idea of how the various options will affect their pay and many may find they actually can afford better coverage than they think or can do so by making some adjustments. Here are a few website calculators you can point them to if your provider does not offer similar tools: Bank Rate Payroll Tax Deductions Calculator and the IRS Withholding Calculator.
Demonstrate Plan Costs for Common Illnesses and/or Hospitalizations
Ensure your provider gives a summary overview of anticipated costs with co-pays, etc. for some more common medical needs requiring treatment. For example, the Healthcare.gov site provides users with cost comparisons for Type 1 Diabetes as well as costs associated with a hospital stay for a routine labor and delivery. This will help your employees have a better understanding of the overall costs of various plans showing how co-pays, deductibles, etc. all come into play and not just the premiums.
Costs and Quality of Care by Provider
Many states have developed websites that permit people to price shop for their healthcare needs beyond selecting their insurance coverage. New Hampshire’s site has a fairly comprehensive collection of data on various procedures that allows users to see the anticipated cost of care for facilities throughout the state based on their insurance carrier and it includes information for anyone who is uninsured as well. Cost is not everything when it comes to healthcare choices, so the site also includes information on quality of care ratings for the providers as well. Just as most people like to shop for the best deal on retail purchases, encouraging employees to do their best in making informed decisions on where they seek care may help keep your group’s health insurance premiums in check. Check out the NH site: https://nhhealthcost.nh.gov/
Prescription Price Comparisons
It is common for insurance plans to require members to obtain their ongoing prescriptions directly from them via mail order or through contracted third party in either 30, 60 or 90-day supplies. While your employees may see some savings in these programs, they may also find that retailers and/or drug stores in their area actually offer less expensive options without insurance. The following site permits people to look up their exact medication and input their zip code, which will provide them with the name of companies in their area and the costs for their prescriptions: https://www.wellrx.com/prescriptions
Stress In-Network Providers vs. Out-of-Network
Ensure that all your employees know the importance (translation: higher cost) of using an out-of-network provider versus one that is in network. This includes when employees travel on vacation or for business. Make sure as part of your rollout you include easy tools whereby employees can easily check in-network providers to see which ones might include their current doctors, dentist, etc. It may also be a good idea to remind employees requesting time off for a vacation to check the provider network as part of their travel preparations should they need to seek non-emergency medical care for themselves or a member of their family while traveling.
Offer an On-Site Flu Shot Clinic
Flu season is once again upon us. With busy family lives, many employees may fail to remember to schedule flu shots for themselves or may simply feel that they do not have the time to do it. By offering shots onsite at your office(s), you may encourage more people to get immunized, thereby protecting your workforce from excessive sick days as well as the potential for costly healthcare expenses should they actually contract the full-blown flu. Plus your employees will appreciate the convenience.
Provide Information in Different Media Formats and at Multiple Venues
If the mountains of paperwork you are faced with are overwhelming for you, imagine how it is for employees to absorb in a single 30-minute to one-hour informative session with your entire company. Employees may have a number of questions once they review the materials provided (if they review it at all). Some employees may be intimidated asking questions in front of a larger group, especially if they feel the question might be a “dumb” one. If you can, schedule your insurance reps to come back a second time for an entire day prior to Open Enrollment to give them a chance to ask questions. Videos, online calculators and tools can also be great ways to condense a complex set of information into a more concise and easy-to-understand format. Just like with any kind of training that you employ for your employees, the more you cater to all the various learning types (kinetic, visual, auditory, etc.) the more likely people are to comprehend what they are learning.
Also, if you do a presentation for all employees and/or offer individual sessions with your insurance provider, consider extending an invitation to your employees’ spouses, partners and/or other dependents. The decisions made on health insurance are typically made as a family and it can provide everyone a chance to ask questions in addition to boosting employee morale by showing your employees that not only are they important to you, so are their families.
Your Own Extra Effort Now, Can Save You in the Future
Don’t get stuck just waiting for your current carrier to provide you with a quote before deciding whether or not you might be better off seeking coverage elsewhere. While it may seem easy to just keep going with the same company because the thought of all the work in transferring information to a new carrier can be intimidating, it could cost you. Just as you would with your own finances before a major purchase, make sure to shop around for coverage and do a complete analysis of the costs that you are paying for and what is truly necessary versus what seems like a must-have, but is never really used. Some firms have even seen benefit by starting their own self-funded plans, which might be something to explore as well.
HIPAA Compliance and Security Audits
For the most part, employers are exempt from the Health Insurance Portability and Accountability Act (HIPAA) regulations, but there are some instances where you may cross the line and your health plan could end up costing you more than just a premium hike. HIPAA is intended to protect electronic personal health information (PHI) of patients and has strict guidelines on who may access such data and typically it is only when permission is given by the patient or legal guardian. Generally speaking, as long as you are not processing claims for your health plan and leave that up to the insurance provider (workers’ compensations claims are carved out of the HIPAA umbrella in this respect), then you limit your exposure and thus your obligations to comply with HIPAA. If you take some of the duties typically handled by insurance-provider type role, are a covered entity to begin with (hospital, clinic, insurer, etc.) or have a self-funded plan that you administer (unless you have fewer than 50 participants), HIPAA will need to be part of your compliance protocols. Either way, Sponsors of plans are required to assess the security of protecting PHI for their plans so you should work with your Provider to assess any security risks in the electronic data for your employees.
Your first step should be to identify hardware, software, facilities, workstations and any IT systems used to store, receive, maintain or transmit PHI electronically, which will also help to identify any PHI that you as an employer might have (information gathered for Open Enrollment does not necessarily fall under this as it is not gathered on behalf of the insurance provider, but for yourself). The next step is to identify and assess that all the appropriate security measures are currently in place to provide the required protects for the electronic PHI. Be sure to highlight any specific vulnerabilities and risks. Lastly, work with your insurance provider to determine if any additional security measures are needed to respond to mitigate against the identified vulnerabilities and risks. Make sure you keep a well-documented account of the entire process as well as the decisions reached to address any risks discovered in your initial assessment. There is no specific timeframes for how often these security audits should take place, but certainly if you change plans you will want to work with your new insurance provider to conduct a security audit.
One of the best ways to help yourself and your employees is to take as much of the pain out of the entire process as possible. Eliminating paperwork, archaic processes and putting easy-to-use tools right at everyone’s fingertips can eliminate so much of the unneeded anxiety of Open Enrollment. It can also help to ensure you are compliant in your processes, on top of dates and have extensive, reliable data and analytics that you and your management team can readily access when you need it. As an all-in-one solution, CheckmateHCM can take so much of the pain out of your Open Enrollments by allowing you to administer your benefits plan with a “carrier connect” to your providers, by automatically sending notifications to your HR, management and the employee when he/she becomes eligible (tracking real-time employee hours in the system) and administering pre-tax payroll deductions as part of your payroll processing. Open Enrollment will probably never be a dream come true for anyone, but at least using CheckmateHCM will help ensure it is no longer one of your greatest nightmares.