Enrollment happens fast.
Most people choose a plan in a few minutes, once a year, from a table of numbers. The decision lasts twelve months and the explanation lasted five.
Four reasons a fast decision turns into a slow regret.
The problem is not that employees are careless. It is that the enrollment window is built for speed.
A few minutes, once a year
Open enrollment competes with everything else on an employee calendar. Few people read a plan summary line by line in that window.
A table with no scenario
Deductible, coinsurance and copay appear as columns of figures. Without a worked example, nothing tells the employee what a real claim would cost.
Defaults decide for people who run out of time
When the window is short, the plan an employee had last year, or the cheapest premium, wins by default, whether or not it still fits.
A choice made once is lived with for a year
Outside a qualifying life event, the plan an employee picks is the plan they keep until the next window.
We build the explanation to fit the window.
We give employees a short walk-through before enrollment opens and a one-page scenario that shows what a normal year and a hard year cost under each option, so a fast decision is still an informed one.
Related pages.
Explain Benefits Before Employees Enroll
The most effective fix for plan confusion is also the simplest: explain the plan before the enrollment window opens, with a real example, in words employees already use.
What should employees see before open enrollment?
At minimum: the summary of benefits and coverage for each option, a plain definition of the key terms, a side-by-side of premium and likely cost, a way to check their doctors against the network, and a named person to ask.
Why do employees pick a plan that does not fit them?
Usually because the choice is made fast, from a table of numbers, with the premium doing most of the persuading.
Avoiding Group Health Insurance Plan Confusion
The full guide to helping employees understand their group health plan.
Questions that come up next.
Short answers to the questions employees ask after this one. Each links to its own page.
Is a high-deductible plan always the cheaper choice?
No. A high-deductible plan usually has a lower premium, but it can cost more in a year with significant care. The right choice depends on how much care the employee expects to use and whether they can cover the deductible if they need to.
What is the difference between a deductible and an out-of-pocket maximum?
The deductible is what an employee pays for covered care before the plan starts sharing the cost. The out-of-pocket maximum is the most the employee pays in a year for covered in-network care. One is where sharing begins, the other is where it ends.
Do copays count toward the deductible?
It depends on the plan. On some plans copays count toward the deductible and on others they do not. Copays generally do count toward the out-of-pocket maximum for covered in-network care, but confirm in your plan documents.
Ready? Send us your renewal, or talk it through with someone first. No cost, no obligation.
General information about group health plan terms, not legal or tax advice. Plan-specific questions belong with the plan documents and the carrier.
Send us your renewal.
We’ll tell you whether it looks competitive, where we see opportunity, and the five questions we’d put to your carrier. No cost, and no obligation to move anything.
The renewal letter
Your current plan summary
Contribution split by tier
Enrolled counts by tier
Four documents, two more if your group is 50 or more. Nothing else; every extra one is a reason to postpone.
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