Here are a few topics to start with to help employees understand their benefit plans better.

Know your benefit plans like your life depends on it.

• Know how your benefit plans work; you never know how important this might become in the event of a serious illness. Learn about your deductible, coinsurance and max out-of-pocket, and which services they each apply to.

• Learn how to find doctors in your provider network.

• Keep handy the Summary of Benefits Coverage (SBC) for your benefit plans, and any other carrier documents, and your comprehensive Fall River Benefit Guide which also provides all the numbers to call for help, along with your policy numbers for handy reference.

• Cost and Quality: Unlike many goods and services we buy every day, a more expensive medical service is not necessarily better. Costs vary widely for the same procedure, and some providers deliver much better quality than others.  Every carrier has a cost and quality tool on their website to help you make sure you’re getting the best value for your dollar, and the best care possible.

Know your provider network inside and out. 

• In-Network? Do not assume providers are in-network because they “accept” your insurance. Be specific and ask if the provider is “contracted” with your carrier or “in-network” for that carrier.

• Referrals? Find out if you need referrals to see a specialist. These 

• Pre-Authorizations? Find out if you need a pre-authorization for certain procedures, visits or prescriptions.

• ER or Urgent Care? There are many new free-standing emergency rooms that look like urgent care centers, and sometimes even say “Urgent Care” on the building! Beware that they may bill you your ER copay or even your deductible depending on what your procedures you have done. Be sure to ask a lot of questions such as “Do you bill as an urgent care or an ER? Will I be billed a facility charge?”

Check the value-added benefits of your benefit plans. Benefit plans often include several resources that you should take advantage of. A lot of these are free, while a few others may be available to you for a small fee:

• Virtual visits and telemedicine: you can video chat or speak to a doctor in the comfort of your home

• Wellness Programs: Your medical carrier may have built in programs that allow you to earn points and gift cards, or have a friendly competition with coworkers for rewards and even a premium discount with some carriers.

• Discounts: for gym memberships, weight loss programs, smoking cessation programs, etc. The list is long and varies by carrier.

• Mobile App: you can easily access your SBCs, paid claims, invoices, test results, etc. 

Most important of all – Ask questions and do not make assumptions!

If in doubt, ask questions! No question is silly in this industry, especially if it impacts your financials. You must advocate for yourself and be as smart of a shopper as you are when you go to buy a new car or cell phone.

We at Fall River Employee Benefits want to provide our clients with the resources needed so their employees are empowered to be the best health care advocates they can be! Helping employees be great consumers of healthcare improves their health and financial bottom line. For those of you who are partially self-funded, or over 100 employees on any type of funding, this can make a big difference in your plan spend as well. 

For more tips and information about health care consumerism, please feel free to reach out to your Fall River Client Manager!