High-deductible health plans (HDHP) and tax-advantaged benefit accounts such as flexible spending accounts (FSAs) and health savings accounts (HSAs) offer significant cost savings opportunities for both employers and employees. Yet they are still widely underutilized and underfunded, translating into billions in missed premium and tax savings for both employers and employees.

Low consumer health and financial fluency has been well-documented and is likely a major contributing factor. But, it's not just the employees that struggle to understand and articulate the value of these programs. Employer HR teams are on the front lines explaining these programs and responding to employee questions, and often their efforts fall short of the mark, something that is unfortunately reflected in their open enrollment adoption rates.

If you want to see adoption rates increase, you must lead them to the right strategy – from plan design, to open enrollment communication, and throughout the plan year.

Let's check out a few plan design strategies that lead employers to increased adoption.

1. Pair an account with every health plan – not just HDHPs & HSAs

In an ideal world, every out-of-pocket healthcare cost would flow through a tax-advantaged benefit account and save the average consumer 30 percent off of their qualified out-of-pocket expenses. But, it's not just high-deductible plan participants that are subject to out-of-pocket costs because most plans have some measure of out-of-pocket financial responsibility. Consider this: 85 percent of consumers in employer-sponsored health insurance are enrolled in a plan (of any type) that is subject to a deductible, yet only 40 percent of those consumers are enrolled in tax-advantaged accounts.

Most employers today still offer multiple health insurance plan designs. Whether they offer a traditional PPO plan (paired with an FSA), a high-deductible offering (paired with an HSA), or any other combination, encourage your employers to think about positioning the plan and the account together as one value proposition that helps employees get the best value for every dollar they spend on qualified out-of-pocket costs.

2. Design high deductible plans to create value, not shift costs

Controlling healthcare costs is one of the primary drivers for employers to adopt high deductible plan options. However, if there is no value in it for the consumer, adoption and benefit satisfaction will suffer. In order to best position HDHP for success, you must encourage your employer to consider the relative costs and value of the HDHP versus all other options offered.

The selection of the HDHP must represent a clear “win” for the employee. Ideally, the HDHP benefit design should offer an equivalent or better actuarial value that considers the average cost of employee expenses that will be covered by the plan, as well as the employer's contribution to the account to help offset out-of-pocket costs.

3. Encourage the employer to contribute to the account

Contributing to the account is the most impactful strategy your employer can use to drive participation in HDHPs.

Not surprisingly, when employers contribute dollars to their employees' health care benefit accounts, enrollment dramatically increases. This is why the majority of employers that offer HDHPs also contribute some amount to the HSA. According to a recent study by the National Business Group, 63% of companies that offer HDHP/HSAs are contributing financially to their employees' HSAs, with a median contribution of $600.

4. Require active enrollment, disrupt the status quo

When faced with difficult or confusing decisions, people tend to stick with what they know; they like familiarity and resist change. If an employee can passively default into their prior year benefit elections, they will most often stick with status quo.

For each open enrollment season, employees should be required to actively make new benefit elections. If the goal is to drive participation in new plan options, such as a HDHP, we want employees to think about their options in comparison to popular legacy plans. Forcing them to actively compare and evaluate plan options, particularly if those decisions are supported with robust education and decision support resources, will give a much greater chance of helping the employee understand the value.

5. Educate your employers so they can educate their employees

Effective communication is a key driver of open enrollment success. Because employers are essential to guiding their employees' benefit decision making, it is imperative that you provide supporting educational materials and resources for your employers too, not just for employees. By training the trainers, you prepare front line people to be a better resource for their employees during open enrollment and throughout the plan year.

Employers need your help

Consumer-directed benefit programs, such as HDHPs and HSAs, have the potential to help employers rein in the cost of their health benefits while simultaneously saving money for employees. It should be an easy sell, but it requires the right plan design, the right funding strategy, and the right communication and support plan.

The number-one thing you can do to help employers increase adoption is simple: Be the partner that supports and guides them through the process of designing and promoting these plans to their employees.

Jennifer Irwin is senior vice president of marketing and strategy at Alegeus.

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Instant Insights /

How to maximize participation in consumer-directed health benefits

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