Approximately one-third of employees do not understand or know anything about their health coverage, according to a 2019 survey by Maestro Health.
To help promote employee health care literacy, we’ve compiled a list of 10 questions that employees should ask their employers prior to choosing group health coverage. Employers can prepare a written Q&A for employees based on these questions. The Q&A can be used during open enrollment, or as a standard communication tool.
Employee Question #1
What kinds of health plans do you offer?
For employers: Describe your group health plan type, including benefits and limitations. Explain the most common types of group health care plans, such as Health Maintenance Organization (HMO), Preferred Provider Organization (PPO), and High-Deductible Health Plan (HDHP), and explain which categories your plans fit into and what their advantages and disadvantages are.
Employee Question #2
Which services are covered under each plan?
For employers: Let employees know which health care services are available through each plan. All of them will include medical care, but you can specify which ones feature dental and vision coverage, or additional coverage for critical or chronic illnesses.
Applicable Large Employers (as defined by the Affordable Care Act) must offer at least 10 essential health benefits, including inpatient and outpatient care, pregnancy and childbirth, prescription drug coverage, and mental health services.
Employee Question #3
Does the plan include family coverage?
For employers: Explain eligibility rules for adding spouses and dependents.
Employee Question #4
How much will I have to pay?
For employers: Define individual and family coverage amounts, cost-sharing amounts (e.g., employer pays 70% and employee pays 30%), out-of-pocket costs such as deductibles, copays and coinsurance, and payroll deductions for premiums.
Employee Question #5
Is there a waiting period?
For employers: If there’s a waiting period, you may want to encourage employees to keep whatever coverage they currently have, perhaps through their spouse’s employer, or from their previous employer under COBRA, until the new plan starts.
Employee Question #6
Does the plan deliver tax benefits?
For employers: If you offer health insurance through a Section 125, or cafeteria, plan, describe the tax savings that employees will reap.
Employee Question #7
Do you offer health care savings or reimbursements accounts?
For employers: If these options are available, explain how they operate and which tax savings they provide. Be sure to emphasize that they are not health insurance but, rather, tax-favored health savings or reimbursement accounts.
Employee Question #8
Do you provide wellness benefits?
For employers: If applicable, clarify which wellness benefits are offered, and any connections to the group health care plan.
Employee Question #9
What happens to my health care plan if I am laid off or terminated?
For employers: Inform employees how long coverage will stay active after they leave the company, and whether they are entitled to COBRA continuation coverage.
Employee Question #10
Can I opt out of coverage?
For employers: Relay the process for declining or waiving group health coverage, and any potential consequences of doing so.