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3 ways to enhance your health benefits plan design this year

To enhance your employer benefits offering and achieve your financial goals, a smart health plan design takes into account these 3 key points.


It’s that time of year — you’re considering your health benefits renewals, you’ve met with dozens of benefits programs vendors, and you’re strategizing on the right options for your people. As you know, it’s a careful selection process to find the right mix of benefits, programs, and vendors for your team. You’re approaching this time-consuming project with meticulous thought and planning, but in the end, how do you ensure that the final product reflects your original intent? To assist you in maintaining the integrity of your health plans throughout the design process, here are our three key recommendations for benefits teams preparing for the new plan year:

Look at all the connecting points. Make sure they actually connect.

To enhance your benefit offerings and achieve your financial goals, you need a smart health plan design that takes a close look at legacy benefits that were built into your past plans, some of which may no longer serve your people. A review of your past plans will help you identify any gaps or oversights in your plan design before you decide to tack on any new plan additions. For example, perhaps your plan covers hearing tests, but not hearing aids. Or fertility treatments, but not genetic testing. Or it covers diabetic supplies, but not nutritional evaluations. Were the choices made deliberately? All of these elements, when not aligned, can create confusion.

A review of your past plans will help you identify any gaps or oversights in your plan design before you decide to tack on any new plan additions

Look beyond benchmarking data to see the whole picture.

Be wary of relying too much on benchmarking – it’s only one piece of the puzzle. You and your consultants likely compare your plans to those offered by companies of similar sizes, locations, and populations. This is a great way to make sure your benefits are staying competitive, so you can continue to attract top talent. You may also look at trend data, which shows patterns in health care claims, though often with some significant time lag. However, neither of these data sources account for inquiry data (what people are asking for) or member satisfaction (how well people like existing plans). And most importantly, neither benchmarking nor trend data reflects the specific needs of your own population.

Control the game of telephone

Plan renewal season is a busy time of year for benefits teams. But all too often, the crucial decisions around initial plan design, Summary Plan Description (SPD) creation, benefit summary drafting, and adjudication coding are managed in disconnected silos. This leads to many of the issues that ultimately confuse your people.

The flow of information typically flows like this: Your team, along with your consultant or broker, carefully reviews your claims data from the previous year and makes thoughtful decisions on next year’s plan changes. Then your consultant conveys these plan changes to the medical carrier for implementation. Your medical carrier account manager takes your list of plan design changes to their team to create the benefit intent summaries, but another team creates the adjudication coding, and yet another team creates the SPD. This division of labor at the carrier level is where things can get complicated. Your consultant reviews the SPD, sends it to your benefits team, you review it again, and after a few rounds of back-and-forth on changes, you have your new plan design. As you can see, these silos deal with a lot of moving parts and any errors along the way may not show up until your claims are processed.

In effect, this complex process reduces your entire thoughtful decision process to a game of telephone. Because your medical carrier was not involved in early discussions, they don’t always understand the intent of your plan changes. They don’t know if you’re looking to enhance your offerings, save money, or meet the specific needs of people in your organization.

Bridging these gaps with consistent oversight and maintaining open lines of communication with your medical carrier can help alleviate the confusion and protect your original plan design intent.

Take a step forward

When health plans are designed on top of existing legacy plans, rely solely on benchmark and trend data, and execute your plan design in silos, you put the integrity of your benefits plans at risk. So what can you do?

With new approaches to plan design, it’s very possible to reduce complexity and frustration, enhance your plan offerings, and protect your bottom line.

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