By Jesseca Oscar
As head of Human Resources for an organization that is in the business of health care benefits, I see every day how important health care transparency is for employees. I expect it will become an even bigger topic since President Trump signed an executive order in June 2019, directing hospitals to tell patients upfront what they can expect to pay for treatment.
That’s a major move in transparency. Healthcare and insurance companies have a lot of work ahead to implement this mandate. In the meantime, I think we can expect even more discussions on what transparency means for employers offering group benefits, and the employees with those benefits.
Fortunately, one of those discussions should be simple. Vision benefit companies are making significant strides in transparency (pun intended!) to make vision an understandable health benefit—one that encourages employee use and drives member satisfaction.
That’s certainly good news, but you may be wondering what transparency in vision benefits looks like—and why it matters.
Why health benefit transparency matters
The key to using benefits is understanding them. And understanding benefits starts with clear, concise communication. But, research shows that doesn’t happen as often as it should. Approximately one half of all employees don’t understand their benefit materials, and only 4% of Americans can define basic benefit terms like “copay,” “deductibles” and “coinsurance.”
As Hub International’s Employee Benefits Barometer 2018 report points out, employers’ number two benefit priority after managing costs is helping “employees make more informed decisions when it comes to choosing and using their benefits.”
With an ancillary benefit like vision, understanding and transparency may matter even more because most employees are making a conscious choice to add vision to their benefit package, often paying the entire cost of the benefit.
Using vision benefits can result in significant savings compared to retail prices on eye exams, eyewear, lenses and more, but those vision purchases generally have out-of-pocket costs for the employee. Employees need to understand how this works, and the key to driving employee understanding and benefit use is driving employer understanding. Brokers can have a vital role to play in that process.
Embracing transparency: the gains and pains
When vision benefits are transparent, the resulting gains can be impressive. In addition to higher enrollment in a cost-effective preventive benefit and healthier employees, there’s the potential for improved productivity thanks to vision care. Slight vision issues can decrease productivity by 20% without the employee even being aware of the problem.
Another plus is potentially smoother discussions come renewal time. No broker wants to spend precious time with a client discussing pains caused by a vision plan.
Because EyeMed has spent years fine-tuning an easy and transparent benefits experience, we’ve learned how to help employees understand their benefit. We’ve also identified a few pain points along the way that your benefit vendors can help you address for clients and members. Here are four of those pain points and solutions to look for.
Pain point #1: Complex benefits and limitations
Confusion with vision benefits can occur around what’s included, at what frequency, and how benefits and discounts are applied. Employees want to focus on what they can do to improve their vision, not on navigating rules and limitations that might prevent them from getting the care and eyewear they want and need. These may even reduce their satisfaction with the benefit.
For example, rather than complex formularies and restricted product selection, EyeMed takes a simple approach to vision benefits, providing a “free-to-choose” model for the member on products, as well as retail-based pricing on all products and services. It’s a consumer-friendly approach that’s easy for members to understand, letting them better anticipate their out-of-pocket costs and leading to a positive and confident eyewear shopping experience.
Pain point #2: Lack of engagement during enrollment
Look for carriers truly focused on transparency to kick off strong member engagement with a variety of educational materials and toolkits to help employees understand the benefit at all stages, from decision-making to benefit use. This increases engagement—and not coincidentally, can increase enrollment as well—a good outcome.
Some carriers will even send experts to qualifying benefits events to help walk employees through decision-making tools, explain how the benefit works, review local in-network options and more.
Pain point #3: Uncertainty on how to use and maximize the benefit
Once the excitement of enrollment has settled, members will use their vision benefits after they become effective, which could be many months later. Here the real test begins. You want members to experience benefits that are simple to use, with easily accessible resources in multiple formats across multiple delivery channels.
It’s particularly crucial that those resources be accessible across many platforms. In EyeMed’s case, we offer:
- Welcome packets mailed to newly enrolled subscribers including ID cards
- A customer care center that’s open for calls 7 days a week, with extended hours
- Online access to an advanced provider search tool, interactive education tools and special offers that can help members maximize their benefit further
- A members’ mobile app to get benefit information on the go
- Ongoing education in a variety of formats—including opt-in text alerts, e-newsletters and more
You’ll know the resources and communications have been successful when utilization is up and members are using in-network providers. These can be key indicators that members understand their benefits and the value they deliver.
Pain point #4: Surprise costs with benefit use
The last thing anyone wants is to get a bill with additional “surprise” costs—which takes me back to where I started. EyeMed believes that in vision benefits, “no surprises” means fixed pricing on options, with benefits spelled out upfront (both in-network and out-of-network). A cost estimator tool for members can also be hugely helpful in avoiding surprises.
Thanks to the Affordable Care Act (ACA), cost estimators are becoming more prevalent. Forty-five states have included such a tool in their ACA implementation.
I’m excited about EyeMed’s online cost estimator tool called Know Before You Go now available to nearly all clients. It lets members view ahead of time an online menu of available eye care services and products, and then see the anticipated out-of-pocket cost. In my world as an HR leader looking for ways to provide a great benefits experience to employees, I’m thrilled that we can help other HR teams and make a difference in benefits transparency.
Expect vision to lead the way in transparency and engagement
I anticipate ancillary benefits carriers and medical insurers will pioneer and perfect more transparency initiatives that improve the member experience. But for now, I encourage you to demand and expect maximum transparency from your ancillary carriers—including your vision carrier—so employees can see all things clearly when enrolling and using their benefits.
I invite you to visit eyemed.com and select “Broker Resources” to learn more about EyeMed vision benefits.
Jesseca Oscar is the head of human resources for EyeMed Vision Care. As a 16-year veteran in the profession, Jesseca has broad experience and a passion for all things HR, from strategy and planning to recruiting, talent management and benefits, and employee and labor relations. Prior to EyeMed, Jessica was director of HR client services at Cincinnati Bell. She earned her B.S.B.A. with a focus on marketing from the Fisher College of Business at The Ohio State University.