Insurance and employee benefits can be confusing. Unless you’ve worked in the industry or have taken the time to understand all aspects of your employee benefits, you may not fully grasp everything your plan does, or doesn’t, offer.

At Salus Group, we strive to make sure our clients and their employees have a strong understanding of everything their plan has to offer, and that they are making the right elections come open enrollment time. We see it every year. Employees do not ask questions before making their elections for the year, then when something happens that requires the use of their insurance, they find out they may not be in the best plan for them or their family.

What we’ve found over the years is that it is not that employees don’t care about the details of their plan, it’s just that they don’t know where to begin when it comes to asking questions. They are unfamiliar with the terminology, or the structure of how insurance works, so instead of asking questions about the plan, they stay silent and elect options they don’t fully comprehend.

Below is a guide to help your employees ask the right questions to ensure they are selecting the right plan for them and their families. (Guide created with the support of findlaw.com)

• Who in your family needs coverage?

 

• When does coverage begin? Is there a waiting period? Some plans have a 30-day or 90-day waiting period.

 

• Can you please explain deductible vs coinsurance?

 

• What is the cost of any medications you currently take? Some plans only cover generic or formulary brand-name prescriptions drugs. Think about how often you or your family members take prescription drugs and how often you use generic vs. brand-name drugs.

 

• How much vacation time, sick time, company-designated and floating holidays are provided? When do these benefits start accruing?

 

• Are my spouse and kids eligible under the plan?

 

• How much is my monthly premium, office co-pays, or prescription drug costs?

 

• Does the plan cover preexisting conditions? Some plans do not cover pre-existing conditions, or require longer waiting periods for coverage to begin.

 

• Is orthodontia covered under this dental plan?

 

• Is my domestic partner covered under the plan? Some domestic partner plans only cover same-sex partners, and not opposite-sex partners.

 

• How much is the annual deductible (the amount you must pay before insurance kicks in)? Also, what are my out-of-pocket expenses, if any?

 

• When does medical, dental, and hospitalization coverage end? Some plans end on the day you leave the company. Other plans offer a grace period (for example, through the end of the month).

 

• What type of pension or retirement plan is there? How much does the company contribute?

 

• Are there any family-friendly benefits, such as childcare reimbursement or back-up childcare?

 

• What’s the difference between the FSA option and the HSA option?

 

• What can I use my FSA/HSA money on?

 

• Does my FSA/HSA money expire?

 

• What are the tax implications of my FSA/HSA

 

• Does this plan include telehealth? If so, is there a premium I have to pay if I use the service? Who in my family is covered under the telehealth plan?

 

• Based on my elections, how much will this cost me per paycheck?

 

• If I leave or lose my job, am I still covered?

 

• I am on my parent’s insurance but am turning 26 soon, am I still covered?

 

• What is the process for filing claims, or processing an appeal? Some plans require you to subject proof of payment before reimbursement, whereas other plans allow a physician to submit claims directly on your behalf.

 

Salus Group represents a diverse collection of clients across multiple industries. These are the questions we anticipate and work to proactively educate employees so that they are armed with knowledge. If you want to make sure you and your employees are getting the most out of their benefits, we’d love to help. Fill out the form below and will be in touch shortly.