Health insurance is becoming increasingly confusing and difficult for the average American worker to navigate. The new complexity makes brokers’ jobs more important than ever, especially during enrollment.

Before the Affordable Care Act (ACA), brokers primarily supported the benefits enrollment process for employees by coordinating plan documents and occasionally making presentations at group meetings. Such strategic benefits communications is what helps employees make informed and confident decisions during enrollment. Although most or all of the ACA may disappear in the next few years, it has still changed the enrollment conversation by accelerating the shift by employers — which are now legally required to provide insurance for their workforces — to higher-deductible medical plans.

Whether employees know it or not, they rely on brokers to help protect them from financial hardship due to the out-of-pocket costs they must pay in the event of an illness, injury or accident. Those costs are higher than ever before, yet most employees don’t understand how much of their health care expenses they would be personally responsible for if they or a loved one got sick or hurt.

In fact, a recent survey, Voluntary Benefits, an Unknown but Needed Option, commissioned by Assurant Employee Benefits, now part of the Sun Life Financial family, revealed that more than half of employees (54 percent) don’t know their insurance plan’s out-of-pocket maximum, and one in three (33 percent) don’t know their deductible. Almost one-third of employees (30 percent) surveyed don’t know either one of these figures. The accompanying report, Closing the benefits gap: How to help employees strengthen their financial safety net, explores how well employees understand their benefits packages and how confident they are in making related decisions.

Enrollment conversation tip #1:

Help employees understand their options

Given the changing insurance landscape, where more of the burden of paying medical expenses falls on employees, it’s critical that they understand their financial risk — especially because the majority of Americans have limited disposable funds to cover such costs. Research shows that more than half of all Americans have less than $1,000 in savings accounts.

That amount won’t begin to cover the significant expenses related to some of the most common afflictions like heart disease and cancer. Statistics show that many people will be diagnosed with an expensive condition at some point in their lives. These conditions account for some of the largest medical costs of any illness, and consumers are bearing an increasing proportion of them through higher deductibles, co-pays and coinsurance. In fact, annual out-of-pocket medical costs for a critical illness average $7,500, according to research based on stop-loss claims data.

That statistic underscores how important it is for employees to know and understand their out-of-pocket maximums, deductibles and covered versus non-covered services. Knowing these things makes them more manageable and less frightening. Answering questions employees may not ask but should ask can help. For example, provide tools, calculators and written information that will help workers calculate how much they would have to spend with each plan option in different scenarios, such as care after a heart attack or a broken bone.

And discuss these things in person, if possible. The Sun Life study showed that such meetings bolster employees’ understanding of their benefits options. Of those employees surveyed who participated in face-to-face benefits meetings, almost all of them (96 percent) found the in-person time helpful.

Studies show that in today’s fast-paced society, people spend only about 20 minutes per year on benefits decisions — choices that could protect or destroy their families’ financial wellness. Yet they spend an average of 14.4 hours researching which car to buy. A car is something people anticipate using all the time, while the opposite is true for insurance, which is something people hope they never or rarely have to use.

Tip #2:

Discuss filling the gaps

The key is to help employees see how big of a hit their wallets would take in different health event scenarios. But it is important not to scare them. So, the second most important part of the enrollment conversation is providing employees with options that will help protect their financial well-being if an illness, injury or accident strikes.

The Sun Life survey revealed that nearly 2 in 3 employees (63 percent) are concerned about how they will pay unexpected out-of-pocket costs. It also showed that employees are concerned about gaps in coverage but lack knowledge about supplemental, or voluntary, benefits:

A majority of employees (62 percent) agree that employer-provided health plans alone are rarely enough to cover unexpected costs.
While most employees (86 percent) feel the onus is on employers to provide options to fill coverage gaps, few of them (30 percent) are familiar with voluntary benefits, and nearly 4 in 10 employees (39 percent) are not at all familiar with this option.
Once the term is explained, 3 in 4 employees (72 percent) say it is important for employers to offer voluntary benefits.
Six in 10 employees (63 percent) agree that voluntary benefits could be helpful in filling the gaps in their coverage, even if they have to pay for the benefits themselves.

Keep these findings in mind as you write materials for and meet with employees, who have been thrust into an environment where they have to take a more active role than ever before in determining their benefits packages. Remember that many of them do not understand even the most fundamental insurance basics, let alone the other options available to them. But they recognize the need for supplemental options once they have a clearer understanding of their benefits landscape.

Tip #3:

Dive deeper to boost customer satisfaction

When consumers pay for something out of their own pockets, they expect more from the product or service they’re buying. With insurance, though, it’s easy to forget about the customer service aspects on the front and back end. Employees often don’t consider this until something happens and they need to interact with a carrier.

As you communicate with employees about their options, help them think through what their experience will be like should they need to contact their insurance provider. They should ask questions such as:

Is there more information online?
How and when will I know what my individual cost will be each pay period?
How long will it take for me to receive proof of coverage (e.g., ID cards and certificates of insurance)?
Who can I call with questions?
Can I submit claims online?

Since we live in a digital age where everything is nearly instantaneous, employees will undoubtedly expect that carrier interactions will be technology enabled. They are comparing insurance companies to other service provider relationships that are likely characterized by technological conveniences. Brokers should work with carriers that offer the value-added services that consumers expect.

Brokers are key to the enrollment process

According to Sun Life research, brokers and employers have an opportunity to help people feel more informed and better about how they’re spending their money through face-to-face communications about both insurance basics and the supplemental offerings that could help them avoid financial hardship.

Brokers are a critical conduit to providing employees with all of the information they need to make important benefits decisions. Meeting employees’ needs — and helping them understand what those needs are specific to their situation — is more important than ever. What can help is to approach the conversation with the mindset that employees aren’t buying insurance because they want to use those benefits, but rather because they want to protect themselves and their families. This approach will help keep the focus on ensuring that employees are mentally and financially prepared for any unforeseen medical expense.

Instant Insights /

3 tips to make the most of post-ACA enrollment conversations

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