Workers Want More Help with Health Plan Decisions

News Updates

U.S. workers said that to make informed decisions about selecting health care coverage options they need a description of the available benefits, a comparison of how the cost of health insurance may change, and a comparison of coverage among available plans, according to the First Annual Transamerica Center for Health Studies Survey.

The July 2013 survey by the nonprofit Transamerica Center for Health Studies (TCHS) polled 1,704 full-time, part-time and self-employed workers, plus 758 employers. The findings highlight how worker and employer perceptions are often misaligned. For instance, when organizations were asked what information they give to workers, only 12 percent reported providing all three pieces of information that surveyed employees said are key. About half of employers provide a description of benefits, 30 percent provide a comparison of coverage options, and 24 percent provide a comparison of how the cost of health insurance may change depending on the option selected.

What’s perplexing about these results is that “a description of the available benefits” and related information is provided in the required summary plan description (SPD) and summary of benefits and coverage (SBC) disclosures.

But these documents “are very high level, and it is possible some employers may not have determined them to be ‘descriptive’ enough to select that answer,” TCHS Executive Director Hector De La Torre told SHRM Online.

Moreover, “Given the unpreparedness by many employers for the SBC requirement last year, it is likely many are still working with the DOL to provide the necessary information,” De La Torre suggested. In addition, the survey sample included organizations that don’t provide health insurance benefits at all.

Among other findings that point to ongoing communication challenges:

  • Employers and workers have conflicting interests over health care coverage. Employers prioritize lower costs over higher quality, while workers emphasize higher quality over lower cost. Sixty-two percent of workers said, “I would prefer to pay more for a higher quality insurance option”; 57 percent of employers said, “My company would prefer to reduce insurance costs even if it means a lower quality health insurance option.”
  • More workers are interested in receiving one-on-one counseling and detailed comparisons of health care benefit options than companies that currently offer these resources. Employees consider online tools and benefits advisors to be the most helpful channels from which to acquire health-coverage-related information; yet organizations are less likely to offer these options.
  • Small businesses (1-49 employees) are the least likely to offer health care benefits, to make changes to their benefits offerings, or to assist employees by providing education or advice about health benefits. Nearly 50 percent of small businesses do not offer health care benefits to any employees, 82 percent have not made changes to their benefits offerings in the past year, and 43 percent have never proactively given their employees education or advice about their health care benefits. Small businesses are also more likely than midsize or large companies to prefer reducing insurance costs even if it means they have to offer a lower-quality health coverage option.
  • A majority of workers and employers said they are prepared to make health care coverage decisions related to the Affordable Care Act (ACA), but many have not taken any action to prepare. Sixty-seven percent of workers claimed they were prepared to make decisions about their medical coverage by January 2014, but 57 percent also said they had done nothing in the past 12 months to prepare for the ACA.
  • Employers and workers share a common interest in wellness programs. Eighty-three percent of employers strongly or somewhat agree that implementing health/wellness and disease-management programs leads to better control of health care costs. And 34 percent of workers identified discounts for wellness services as an element missing from their health care options. Older employees value this benefit less than their younger counterparts.

“With the health-care-coverage landscape on the verge of a wholesale shift, now is the time for workers and employers to begin to be fully aligned on what workers need to make informed decisions relating to their health care coverage,” De La Torre said.

Stephen Miller, CEBS, is an online editor/manager for SHRM.


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