Top 10 questions for employees to ask their employers when enrolling in a health insurance plan:
#1: Has your prescription drug coverage changed?
The Best Practices survey found that nearly nine in 10 (88%) employers identified managing prescription drug expenses — especially for specialty drugs — as their top priority. Find out if your employer has put in new approved drug lists, implemented exclusions or established new approval process provisions that might mean your drugs are no longer covered, must be preapproved or will cost you more money. A change in pharmacy benefit managers, or suppliers, might also trigger changes. Employees who use brand-name drugs might find new requirements for generic drug utilization or might want to consider switching to a generic or lower-cost alternative where available.
#2: What is the status of health coverage for your working spouse or children?
Our survey showed that 28% of employers have already reduced the amount they contribute to spousal coverage by adding surcharges for coverage when it is available through a spouse’s own employer. The percentage of employers adding a working spouse surcharge is expected to nearly double by 2018. The average surcharge is now about $100 per month in addition to required premium contributions. If you have coverage for a working spouse this year, find out if your employer is adding or increasing the amount of an existing surcharge. While less common, employers are also making changes in employee premium contributions to cover dependent children, so ask about that as well.
#3: Are my preferred doctors and other medical service providers still covered?
Some employers change health insurance companies, plans or provider networks to better manage costs. This can mean that your preferred doctors and hospitals are no longer in the provider networks available to you. If you want to continue with your current providers, find out which of your new plan options they accept. Or if your employer has negotiated lower costs with certain providers, you might want to consider switching some or all of your providers to lower your own costs.
#4: Have you taken steps to make health care costs more affordable for me?
Concerned about affordability of health care costs, some employers have made changes specifically designed to lower out-of-pocket costs at the point of service or have lowered premium contributions for low-wage workers. Other employers now offer account-based health plans with tax-advantaged health savings accounts associated with them and have seeded the account to help you cover increased out-of-pocket costs. Find out if this is a new action your employer has taken this year. In addition, when you have a choice in plans, consider your real needs and avoid over-insuring by purchasing a plan that offers more coverage than you need to meet your likely needs.
#5: Have you changed administrators for medical benefits?
One way employers can manage costs and keep plans affordable is to periodically evaluate the health plan that administers the medical benefits they offer. These third parties administer claims and provide the other services associated with the medical benefit program. A new administrator might not affect your costs, but it could mean you have a new telephone number to call or a new process to follow for filing claims or seeking information. Also, new services may be available that can make the claim and inquiry process easier. If you see a change in administrators, make sure you are clear on any new services or processing requirements.
#6: Are you offering new or expanded options for receiving care that might be beneficial to me?
Where you receive medical services can make a huge difference in your out-of-pocket costs. Today, nearly 64% of employers offer telemedicine consultations with doctors or other care providers when appropriate, which are considerably less expensive than in-person doctor’s office, urgent care clinic or emergency room visits. In addition, a growing number of employers are contracting with centers of excellence that have proven to deliver better results and higher-quality outcomes for back, knee, cardiac, infertility and other issues. Employers often offer employees incentives for using centers of excellence. Make sure that you know which of these types of services are available to you and that you understand the circumstances under which they would be most beneficial.
#7: Have you added new or expanded voluntary benefits I might find valuable?
Voluntary benefits are gaining traction with employers interested in meeting the needs of a more diverse, often multigenerational workforce. They have the benefit of being relatively low cost for both employees and employers. Depending on your needs, conventional voluntary benefits such as dental, vision, life and disability insurance might make sense for you. Emerging benefits such as student loan refinancing programs, identity theft protection or even pet insurance might also be attractive. Find out if your employer is offering any new voluntary benefits this year.
#8: Does your wellness plan have new features that can help me manage my health or save me money?
Some employers are adding capabilities to wellness programs such as lifestyle coaching or fitness wearables available at low or no cost for tracking exercise activities or nutritional intake. Plus, there are now mobile apps connected to wellness platforms that can automatically send you recommendations or reminders to prevent or manage existing health conditions. Many employers also offer financial incentives for taking advantage of these capabilities as well as other health improvement activities. Some employers are instituting surcharges for tobacco use or implementing tobacco-cessation programs to help smokers quit. Make sure you understand the different offerings, and the terms and conditions of your employer’s wellness program. Don’t leave money on the table.
#9: Have you added or expanded coverage for complementary or alternative medical services?
Even though complementary and alternative health services such as physical therapy, chiropractic, acupuncture and massage have become commonplace, many health plans offer minimal, if any, coverage for these services. Even if you can afford to pay the full cost of these services yourself, find out whether your health plan or your employer through other types of coverage will reimburse you for some or all of the costs you incur.
#10: Have you added or expanded the use of technology for delivering and managing my benefits?
Technology-based solutions to help you evaluate, select, enroll in and manage your employee benefits are growing in popularity — from private benefit exchanges with decision support tools such as out-of-pocket cost calculators and recommendation engines that offer a consumer-like shopping experience, to web-based enrollment portals and mobile apps. Make sure you know what your employer has already put in place or is considering so you can take full advantage of your power as a health care consumer.
Cosmo Insurance Agency is an independent insurance agency serving surrounding communities in New Jersey. Cosmo keeps its promise to assure an efficient and creative approach to the services we offer. Each of our clients experience a personalized and long-term relationship with us. Our New Jersey based team of health brokers guides our clients in helping them choose the most cost-effective options. By incorporating the latest in technology-based tools and laws on healthcare, employee benefits, life insurance and finance, we keep our clients up-to-date with the plans that encompass all of their needs, whether it is individual or group insurance.
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