September 9, 2016
Small businesses are making many changes to health insurance offerings, and those changes are leading to employee questions. As a result, the appropriate communication from advisers is vital making benefits a success. Zane benefits shares its top 10 questions received from employees.
Who selects my health insurance plan – me or my employer?
The days of offering one insurance plan are gone for employers, replaced with a menu of plans or even exchanges, public and private, full of choice.
“As an employee, it is important to understand who will be selecting the health insurance plan – you or your employer – and if applicable, which policies are available to choose from,” Zane Benefits notes.
How is my employer contributing, and how much?
With most health benefits both the employer and employee contribute. “For example, if the employer offers a health insurance policy, employees generally pay a portion of the premium each paycheck,” Zane Benefits says. “With a reimbursement benefit, employees purchase their own insurance and are reimbursed by the employer on the their paycheck.”
When am I eligible to enroll?
New hires and newly eligible employees must understand the timing of their benefits. Many companies have mandatory waiting periods or eligibility criteria that need to be satisfied before enrolling.
What are my monthly costs for coverage?
Most insurance plans require employees to contribute. By understanding monthly costs, employees will know how they can pay and budget for their contribution.
What are my costs when I receive care or fill a prescription?
Out-of-pocket costs should be calculated when comparing different coverage options. “By working through different scenarios and estimating your medical usage for the year, you can estimate of your annual costs under a plan,” Zane Benefits explains.
Is my current doctor in-network?
Keeping current doctors may be important, so employees should research the network of providers for different policies.
Do I need dental, vision, or other coverage?
Another popular question is, “In addition to major medical health insurance, would other benefits such as dental, vision , or other ancillary policies such as dental, vision, or ancillary policies be a smart choice?” Employees should know if their employer offers additional policies or would reimburse for additional coverage.
What is the difference between and HRA, HRP, HSA and FSA?
As more companies move to consumer-driven and account-based health benefits, there is a shift to health reimbursement arrangements, health reimbursement plans, health savings accounts, and/or flexible spending accounts. All of these account-based health plans offer tax-free reimbursement (or payment) for qualified health expenses, though they all work differently.
What is the process for filing a claim, appeal or reimbursement?
Each plan is different and some may require proof of payment or coverage before reimbursement, whereas other plans allow a provider to submit claims directly on your behalf. Employees should understand the requirements for coverage before accessing care.
What happens if I leave the company?
With an increasing mobile workforce, job changes are frequent. As a result, employees must understand what happens to their benefits when they switch jobs.
“If you purchased coverage on your own, and your employer’s benefit program reimburses you for coverage, you will be able to keep the coverage when you change jobs,” Zane explains. “If you purchase employer-provided coverage, however, you will most likely lose coverage when you change jobs.”