Looking at the decision from the employee’s side of the table.
Choosing a plan is hard because the stakes are uneven. Premiums are visible every pay period and costs of care are not visible until they arrive. Employees who are healthy lean toward the cheapest option, and those with a known need lean toward the richest. Both can be rational, and both can leave the employee surprised.
Good plan choices come from showing employees the same four facts every year, in the same sequence: the amount taken from each paycheck, the amount they cover before the plan pays, the highest total they could owe in a year, and whether their physicians participate in the network. Using one steady layout year after year turns checking all four into a habit.
Why do employees pick a plan that does not fit them?
The usual reason is speed: the decision is made quickly, off a grid of numbers in which the monthly premium dominates. Seldom does anyone illustrate what a difficult year would cost or encourage employees to confirm their doctors participate.
Back to avoiding plan confusion
Do employees need decision tools?
Tools can help, but a clear one-page comparison and a short Q and A session often do more. Choose what your employees will use.
How do we know if employees are choosing poorly?
Look at the mix of plans, the number of mid-year questions and complaints, and what employees say in follow-up surveys.
What is behind the short answer.
The short answer is above. These are the details that decide it for a specific plan.
The premium is the loudest number
It is the one that shows up in the paycheck, so it carries the decision.
Last year’s plan wins by default
When time is short, many employees keep what they had, whether or not their health needs have changed.
The network goes unchecked
A plan can look right and still leave an employee’s doctors out of network.
Nobody showed the bad year
Without a scenario, the out-of-pocket maximum looks like a number on a table, not a bill.
We fix the decision, not the employee.
We build the explanation, the comparison and the network check into enrollment, so the information that changes the choice is in front of the employee when they make it.
Related pages.
Why Plan Confusion Starts at Enrollment
Most people choose a plan in a few minutes, once a year, from a table of numbers.
Compare Total Cost, Not Just the Premium
A plan’s premium is just one slice of what it costs an employee.
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.
Avoiding Group Health Insurance Plan Confusion
Our complete guide to helping employees make sense of 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.
What should employees see before open enrollment?
Employees need, at a minimum, each option’s summary of benefits and coverage, simple explanations of the key terms, premium and expected cost laid out side by side, a tool for confirming their doctors are in network, and a specific person they can ask.
Is a high-deductible plan always the cheaper choice?
Not necessarily. Monthly premiums on a high-deductible plan tend to be lower, but a year of heavy medical use can reverse that. The better pick turns on how much care the employee anticipates and whether they could pay the deductible if it came due.
Who should an employee call about a claim they do not understand?
First, call the member services line on the back of the ID card, where staff can walk through how the claim was handled. Where that still leaves questions, the employee turns to their benefits contact, who can review the plan documents and the explanation of benefits together.
Ready? Send us your renewal, or talk it through with someone first. No cost, no obligation.
This is general background on group health plan terminology, not legal or tax advice. Questions tied to a particular plan are answered by 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.
An independent employee benefits consulting firm. We look at the entire benefits program — cost, plan performance, risk and administration.
Switch to CFH. Unhappy with your broker? Your employees won’t notice. You will. →
Cookies on This Site
We use cookies to keep the site working properly and to understand how it is used. You can decline anything that is not essential. See our Privacy Policy for the detail.
- Essential — needed for the site to load and for you to move around it. These cannot be switched off.
- Analytics — tell us which pages get read, so we know what is worth writing more of.
- Advertising — set by third parties such as ad and social platforms to measure and target campaigns.