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Top 5 questions employees ask about their new health insurance plan

Posted by AllWays Health Partners blog team on January 14, 2021

Switching health insurance plans can bring up a lot of questions from employees looking to ensure they have everything they need to start using their health benefits. Employers can help during this time by making sure employees know where to go to get answers. For quick references on answers to commonly asked questions, we connected with our customer service team to learn five of the top questions they get asked from new members.

1. Is my provider/specialist in the network?

People want to get care from providers they are comfortable with. Often when switching health plans, the question of whether those providers are in-network is a big one, especially for patients whose health care needs involve the services of a specialist.

To help your employees find this important information about their plan, you can direct them to that plan’s Provider Directory. This will allow them to search for their doctor and specialists to confirm that they are part of the network. For many health plan websites, it’s important they pick the plan specific to their company’s offering. If they learn that their providers aren’t covered, this tool can also help them find a new primary care provider or specialist in their area. Because employers often pick a new plan based on minimal provider disruption, it’s a good idea to call Customer Service to double check if a provider is in the network.

2. What procedures/services will my plan cover?

After checking in on their providers, new members often want to make sure that any procedures or services they expect to have done are covered by their plan, and what those services will cost. Typically, the easiest way for new members to find a full list of covered services is through the health plan’s member portal.

By creating an account on the member portal, members will have access to all their important plan documents. This includes the Summary of Benefits and Coverage, which provides a summary of important cost sharing questions and coverage for common health care services. For more detailed information, members can find a complete list of covered services and their cost sharing on their Schedule of Benefits. It’s a good idea to encourage all newly enrolled employees to sign up for an account on their health plan’s site so they have on-demand access to information when they need it. Health plan member apps are also great sources of cost-sharing information on the go.

AllWays Health Partners members can register for an account and download the member app at allwaysmember.org.

3. How does my cost sharing work?

The different types of cost sharing can be one of the most confusing parts of health insurance, so it’s no surprise that many new members have questions after looking into their plan details. The best way to help employees understand their health insurance costs is to make sure they know the definitions of the terms that appear on their plan documents.

When it comes to cost sharing, the most important terms are: copayment, deductible, coinsurance, and out-of-pocket maximum. It’s also helpful to discuss the differences between preventive and diagnostic care to help employees avoid unexpected cost sharing. Some health plans, like AllWays Health Partners, offer explainer videos on understanding basic cost sharing.

Read more: 6 types of health care terms your employees should know

By promoting health insurance literacy among your employees, you’ll make it easier for them to choose the right plan and get the most out of their insurance coverage.

4. Are all my dependents enrolled?

For families that have multiple people enrolled, the process of switching health plans is even more involved. To verify that all dependents are on the plan, employees can log in to their health plan’s member portal. This will show the subscriber their information as well as that of any dependents, including each person’s primary care provider and member ID number. If there is any issue with dependent enrollment, employees can contact their plan’s Customer Service team to address the problem.

5. When is my member ID card scheduled to arrive?

After they’ve enrolled in a new health plan, your employees may be anxious to receive their member ID card, especially if they have a doctor’s visit or procedure coming up soon. Fortunately, it usually isn’t necessary for them to wait for their card to arrive in the mail for them to start using their health benefits. Instead, they can access a digital version of their ID online through the health plan’s member portal or member app. This can then be saved to a mobile device or printed out and treated like a regular ID card.

Of course, if members have gone a while without receiving the card in the mail, they can always reach out to their plan’s Customer Service to check the status of their card. A representative can make sure the address on file is accurate and potentially have a new card issued if the other never arrived.

Topics: Benefits

Disclaimer: The content in this blog post represents the clinical opinions of the providers at AllWays Health Partners and is based on the most currently available clinical and governmental guidance.

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