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. Few employees see a worked example of what the plan costs in a hard year, or check whether their doctors are in the network.
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
The premium is only one part of what a plan 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
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.
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.
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.
Who should an employee call about a claim they do not understand?
Start with the member services number on the back of the insurance card, which can explain how the claim was processed. If it still does not make sense, the employee should call their benefits contact, who can look at the plan documents and the explanation of benefits.
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.
An independent employee benefits consulting firm. We look at the entire benefits program — cost, plan performance, risk and administration.
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