Open Enrollment : Guiding Employee Benefit Choices
Health plans in the post-Affordable Care Act world know that the more people who sign up for coverage during open enrollment, the wider the risk pool is. Similarly, having more employees sign up for the group benefits offered by an employer during open enrollment spreads the cost of the insurance over a larger more diverse group of people and allows insurance premiums to balance out.
Employers and employees agree that benefits are a key driver to both attract and retain talent. Approximately, 49% of people who work are offered some form of healthcare. That number is projected to grow every year. And high employee satisfaction with their employer-sponsored benefits contributes to job satisfaction. And yet today a significant number of employees say they do not fully understand the benefits that they have. They also want their benefits education to continue throughout the year. And they want their member communication options to reflect the changing way they interact with service providers since consumers have grown increasingly accustomed to digital self-service across all facets of their personal and professional lives.
Despite the numbers and the variety of benefits choices for employees, many employees wait until the last minute to enroll and then rarely, if ever, update their coverage again. The only time that employees tend to change their healthcare is when they change jobs...and then they go through the same confusing enrollment process again, perpetuating a cycle that negatively impacts their benefits coverage and influences their experience going forward.
In this three-part series of blog posts, we address why open enrollment is something that so many employees avoid until the last minute, finding it to be a confusing if not frustrating process. In this first post, we address the basics details of open enrollment and the differing benefits needed for different age groups, particularly people approaching 26 and 65. In the second post, we will discuss the information that is gathered during open enrollment and how it can be used to guide member care management. And in the third post, we will discuss the importance of employees being able to easily choose and change their Primary Care Physician and quickly find other in-network providers for better quality of care and savings.
Open Enrollment: Details
Open Enrollment is the only time that employees can sign up or renew their benefits plans with their employers (following their initial enrollment when they are hired) barring significant life events, including , birth, adoption, or divorce. While this process occurs the same time each year, employees’ expectations of a time-consuming, complex, and confusing process can result in them waiting until the last minute to review their options for the coming benefit year. And when it isn’t easy to understand what is new versus different, and how to align their current needs to all that is available, they may default to keeping the benefits they have. This can create missed opportunities to improve quality of care, wellness, along with cost savings for the member, their employer, and the health plan.
For many employees, understanding the enrollment process, timeline, and their applicable benefits options is difficult. From the plan packages and associated costs to specialized terms and insurance jargon, many people don’t know what’s being presented, and what is of value to them. And even more have no idea who to ask for help, as the clock ticks down to the open enrollment window closing.
Employee engagement leading up to, during, and beyond open enrollment is something that health plans should be actively maintaining and encouraging, using two-way conversations about overall health and wellness throughout the year.
A One Size Fits All Approach Leaves Many Behind
People’s needs are diverse and driven by various factors. They may be single, or have a partner or spouse. They may or may not have children. They may be interested in routine medical care, or may want to be sure their acupuncture visits are covered. Employees want to confirm for themselves whether or not their current doctor is in-network or not. Plus there are price considerations, with some people preferring lower out of pocket costs for copayments and deductibles, while others are looking to lower their health plan premium.
When employees are invited to a portal, and all are given the same list of available plans on coverage documents that are 20 pages long in a size 4 font with each medical procedure itemized, the burden is being placed on them to become benefits experts. Each employee wants to select their health plan with the confidence that what they purchased addresses what is most important to them. And since most (if not all) employees are not health plan experts, their experience today leads to confusion, frustration, and an inability to choose.
There are also two key moments when age is important. When a young adult turns 26, they are no longer eligible for dependent coverage on their parent’s plan. At the age of 65, employees are eligible to enroll in Medicare. In both instances, you have a member who may not even realize they are nearing a milestone where they are either required to move from their current plan or where they may be able to save money by shifting to benefits not previously available to them. In either scenario, their current health plan has one chance to retain that member by giving them months of lead time, including easy access to the information they need to make a fully-informed decision. Reminding these members of the upcoming open enrollment deadline helps them avoid any financial penalties, research their decisions ahead of time, and leave behind any of the associated fear and frustration.
Ushur Can Help
Ushur’s Customer Experience Automation™ platform can help. With our ability to connect with members on the channel of their choice, be it SMS, email or chat, our Invisible App™ offers an easy, personalized, and secure process to guide employees through the open enrollment journey. And open enrollment is just the beginning of the meaningful interactions that Ushur can automate between members and their health plan. Periodic coverage questions can be easily asked and answered. Health Risk Assessments can be pushed out followed by reminders. Tailored wellness programs can be offered, and members can easily add dependents, change their PCP or look for other in-network providers.
Assisting you to evolve from annual health insurance “set it and forget it” buying transaction, Ushur can enable health plans to form a partnership with each member—a partnership focused on their shared goals of a great member experience, excellent quality of care, improved health outcomes and increased cost savings. Intuitive Conversational AI removes the friction from those moments when the health plan reaches out to their member or the member reaches in. Come open enrollment next year, members will explicitly choose to renew, versus stay put by default.
Ushur offers a no-code solution allowing your teams to rapidly build automated communications to reach your members not only for planned, critical interactions but also when emergency outreach is needed. Even without having to download an app to their computer or phone, members can still experience the ease and speed of finding and providing information using virtually any data format. Ushur’s robust APIs integrate with your core systems to store and retrieve data so your members can access information about their benefits and coverage when and where they want it.
Learn more about how Ushur can transform your Open Enrollment to elevate member experience, drive quality of care and outcomes, and offer cost savings.
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Ushur delivers the world’s first AI-powered Customer Experience Automation™ platform that has been purpose-built, from the ground up, to intelligently automate entire customer journeys, end to end. Designed to deliver delightful, hyper-personalized customer experiences through rapid issue resolution and unified, omnichannel engagement, Ushur is the first-of-its-kind system of intelligence. It combines Conversational Automation and Knowledge Work Automation in a No-Code, Cloud-native, SaaS platform to digitally transform every step of the complete enterprise customer experience – from Micro-engagements™ to entire customer journeys.
Backed by leading investors including Third Point Ventures, 8VC, Pentland Ventures, Aflac Ventures and Iron Pillar, Ushur’s Customer Experience Automation™ solutions are currently in production at some of the leading insurance providers across the globe including Irish Life, Unum, Aetna, Cigna and Tower Insurance.
Have you ever wished that it was easier to interact with an insurance carrier? We all know that waiting on hold for what can feel like forever and scouring the Internet for answers to seemingly basic questions are major hurdles that can cause most customers to approach simple tasks, such as filing an insurance claim, with caution and dread. With Ushur’s omni-channel Virtual Customer Assistant (VCA) powered by Conversational AI, insurance carriers can automate servicing for their end users in their channel of preference. That’s why Ushur has added WhatsApp, a popular communication tool used by 2 billion people worldwide, as a communication channel.
The insurance policy is a contractual agreement that stipulates, in exchange for payment, a person or business will receive reimbursement or financial protection against losses from an insurance company. In other words, if the required premium is paid, a customer will be paid for covered damage, injury, illness or loss.
Insurance is one sector of the financial services industry which has faced challenges as it embraced the digital revolution - first by choice and then by necessity following the pandemic lockdown. Cloud computing has taken hold, but some carriers are early in exploring solutions like artificial intelligence and machine learning.Insurance companies are eager to find technologies that cannot just improve but differentiate their overall customer experience, ideally while also reducing operational expense. One specific area insurance companies are looking at closely is claims service and process automation or as Ushur likes to call it, the future of insurance.
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