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Is your company's health benefits leaking cash or facilitating care?
It's 2am, and an employee's child is ill. Does your plan pay the bill for an ER visit or create another less stressful, less expensive alternative?
An employee visits two physicians, each of whom prescribes a medication. The prescriptions are filled at separate pharmacies. The meds are contra-indicated. Does your health plan or participant know? How?
An employee needs an expensive, but schedulable, surgery. Does your plan help them find the best doctor/hospital? Do you have alternative, more cost effective alternatives?
I look forward to seeing everyone's answers.
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2 Answers
The crux of the answers to the questions posed do not lie with the plan but rather with education or resources about benefits and participant rights and responsibilities. Employers can choose to simply distribute SPDs or engage plan beneficiaries in ongoing education using the full range of communications tools available. It starts with someone within the organization, or an external expert, understanding the offerings and being able to explain content in understandable terms. Too often I hear employers say,"No one understands this stuff." Or the first time someone digs into details is when a serious illness occurs. I have written a great deal on the topic including The Employee Benefits Answer Book. Creating a culture where all benefits are understandable, not only health, is in an employer's best interest. Here are some helpful links for employers: http://www.allbusiness.com/staffing-hr/16209400-1.html
http://www.allbusiness.com/media-telecommunications/internet-www/15580266-1.html
http://www.allbusiness.com/allbusiness-open-enrollment/16706656-1.html
http://www.wiley.com/WileyCDA/WileyTitle/productCd-0470525150.html
These are some of the same scenarios I use in enrollment meetings.
At 2am pull out your insurance card. Start with the toll free nurse line, choose a 24 hour urgent care clinic over the emergency room.
Prescription Drugs, unless your health plan is Kaiser, no one at the health plan will know you're taking drugs that don't mix until the claim is filed. Unless, your prescription drug card is used and then the PBM company will know right away. Most likely the pharmacy won't fill the prescription or the PBM or health plan will call and make sure you don't mix the drugs.
Out patient surgery is better than in hospital. Many urgent care centers offer employers discounts for being "preferred" and getting access to advertise that fact to employees. Most likely is have the conversation with your doctor and pick a place you're comfortable with.
With health plan benefits shifting more of the cost to employees I tell them to think of the choice of getting care the same as buying a Lexus. Compare your options, cost and be engaged in understanding what is covered and how much it will cost.
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