I recently attended a health benefits enrollment information session at my university. The purpose of the information session was to inform employees (faculty & staff) of their health benefit changes and options under the new health benefits provider and plan administrator. The administration of both the enrollment process and the monitoring of the entire program is usually placed under the organization’s human resources (HR) management department. The HR department does an outstanding job in setting up the overall program and monitoring the program’s effectiveness and smooth operations. However, they can really only control so much in that they rely heavily on the selected healthcare organization to do its job and administer the health benefits program appropriately and in a user-friendly manner.
While I watched the healthcare organization explain the benefits and the intricacies in the presentation, I couldn’t help notice the bewildered looks on the faces of many of the members in the audience, to include myself. To be honest, I have had over thirty years experience in the healthcare management field and understand most of the complicated issues associated with health insurance, benefit selection, and management of your healthcare expenses. The briefing we attended was fairly brief (less than 40 minutes) considering the level of detail and the complicated nature of the material. While the speaker did ask (numerous times) if anyone had questions and he did answer several questions, I could not help wondering whether all the other folks were somewhat overwhelmed about the choices and options that were presented to them. While I believe myself and others could have asked many in-depth questions, I sincerely felt it would have confused others even more and probably taken longer than the speaker really had to offer.
During the presentation, issues such as if you or your spouse opens a flexible spending account (FSA), then you are not eligible to open a health saving account HSA) and if you try to select certain options, you violate IRS rules and/or government statues that may apply. Also, some medical expenses apply to your deductible, but others do not, and whether you are in or out of network and what options you chose significantly affect your out of pocket expenses. It felt like you were in some TV commercial that indicates you can do this, but you can’t do that and certain exclusions may apply by law on every other Monday, unless of course you get your care on Tuesdays, but occasionally restrictions are lifted on holidays. The numerous permutations were enough to make your head spin.
To understand the magnitude of the situation, you basically must predict your future healthcare needs and the needs of your family in order to choose the high deductible plan or the Preferred Provider Plan (PPO). Additionally, you must decide whether your family will utilize a provider that is in or out of network. The consequences of choosing unwisely can be significant in terms of direct costs to the consumer. Additionally, this does not even count the decisions you must also make about your vision and dental plans as well. Another colleague has been using the high deductible plan for the last few years and is pretty good at running the numbers concerning the costs and benefits associated with the various plans (he has a doctorate in accounting). Today, he told me that for this year he probably chose the wrong plan and it will cost him more out of pocket than he originally had planned or predicted his family would spend. Obviously, if very intelligent individuals have trouble predicting and choosing their health plans accurately, the average American citizen doesn’t have a prayer.
My main question is that do we really have to make it so complicated and so hard to choose the correct plan! Choice and options are certainly wonderful opportunities, but sometimes too much information and too many alternatives or caveats create more confusion than benefits. I will say that many of the health plans provide websites and tools for individuals in an attempt to assist them in their choices and to help navigate our complex healthcare system, but really, can’t we devise a simpler more user-friendly mechanism? What do you think?
