The Right Fit: Open Enrollment the Best Time for Employees to Review Benefits

Open enrollment is upon us, and as employers have focused on building benefits packages for their companies, how can employees ensure they are getting the most out of their benefits?

A comprehensive package should include a core health care package consisting of medical, dental, vision, life and disability insurance coverages. With all that covered, employees can turn to their employer to get a full understanding of their benefits.

“Although HSA (health savings account) plans and higher-deductible PPO (preferred provider organization) plans are still the norm, employers are beginning to look for ways to improve the employee user experience while optimizing the PPO network,” said Beau Reid, senior vice president and shareholder at Holmes Murphy.

Having a conversation with the benefits administrator can give full transparency and ultimately cost savings.

Reducing the cost

With health care costs a top concern, employees should consider tax-sheltered spending and savings accounts, like flexible spending accounts (FSA) and health savings accounts (HSA). These accounts allow the employee to contribute pre-tax dollars to pay for out-of-pocket medical expenses. Some of these plans are “use-it-or-lose-it” so careful planning is important.

“Public pay is now way north of 50% in Nebraska, even [in] the eastern part of the state, which puts tremendous pressure on our hospital systems and magnifies the cost shift to the private sector,” Reid said. “Private employers are now trying to identify the most cost-efficient pathways within the PPO Network, and then are utilizing technology to put the power of this information into the hands of their employees and insureds.”

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Employers are also seeing tremendous cost savings in carving out specialty medications. In most instances, there is aid available to the employee at equal to or lower cost than if it were covered by the plan.

Additionally, using prescription drug manufacturer coupons can help with member out-of-pocket costs of some high-cost prescription drugs.

Individuals should also be aware that Affordable Care Act-compliant plans include preventive benefits, including annual exams, cancer screening and immunizations, according to Mary F. Drueke-Collins, vice president of employee benefits at Swartzbaugh-Farber & Associates. If employees take advantage of this 100% coverage, it will help keep people healthier and lower the overall cost of the health plan.

For those working for small to mid-sized businesses, level-funded health plans have potential savings for both the employer and employee. An employer pays a set monthly fee to cover expected claims.

“The popularity of level-funded underwritten group health plans has grown rapidly amongst businesses with five to 99 employees,” said Mike Mandolfo, president of Strategic Benefits. “Level-funded health plans offer employers significant upfront savings, customized portfolio of desirable health insurance plans, with potential year-end claim surplus refunds back to the employer. It’s become a win-win for employers and employees.”


In addition to health plans, employers are now offering the convenience of digital care.

“Personalized programming delivered on a digital platform, mainly app-based, has exploded due to convenience and cost-effectiveness,” Reid said.

These include digital physical therapy, digital primary care, and digital diabetes monitoring and care.

Some insurance companies like Blue Cross & Blue Shield of Nebraska and Aetna provide 100% coverage on office-based mental health services on some of their plans. This is also happening for some prescriptions, like diabetic insulin. Keeping people with chronic conditions compliant with the prescriptions helps lower future health care costs. Insurance companies also offer weight-loss programs and include wellness programs in their coverages.

When it comes time to select a plan, Reid urged employees to consider more than the premium cost.

“The biggest mistake I see young employees make is to buy solely on price without understanding why a program may be less expensive than the alternative that is provided,” Reid said.

Employees should investigate the coverage to fully understand the benefits and weigh the pros and cons. They may find that they are saving more in the long run with a higher premium.

“Employees should consider the total cost of their coverage, which includes both the cost of premiums and the total out-of-pocket they will pay for their medical care,” Drueke-Collins said. “Sometimes, the highest out-of-pocket/lowest premium plan is the lowest cost.”

Take advantage of the supplemental plans that will help with unplanned care. For instance, if you have kids in sports, accident plans may be a worthy option. Employees can use tax-sheltered accounts to help pay for out-of-pocket expenses.

“It’s important for employees to know what health care benefits they’re enrolled in, and which household family members are covered under each benefit plan,” Mandolfo said.

Employees should become familiar with in-network doctors, dentists, and vision providers covered under their plans. They should also know their cost share for most basic services under each health care plan. Employers can help educate employees by holding annual benefit meetings and providing accessible material so employees can familiarize themselves with benefit plans and networks.