Date: Mar 23, 2020
Magazine:
March April 2020

Employers and employees have a common goal when it comes to health care, and that’s to save money. Most employers are seeing a rising cost of health care, which ultimately and unfortunately gets passed on to their employees. Many employers implement programs to reduce costs for all parties, which can include health and wellness and care management programs. However, employers tend to overlook something as simple as education when it comes to lowering costs of health care.

It may not come as a surprise to learn than an estimated 33 percent of employees don’t understand or know how to utilize their health care coverage, according to Maestro Health, an employee health and benefits company. Going even further, the research found that employers aren’t doing enough to educate their employees about their benefits.

A 2018 Policygenius poll showed that the majority of Americans’ inability to understand basic health insurance terms is the major cause for not fully understanding their benefits package. For example, only 50 percent of Americans can correctly identify what a deductible is; 22 percent understand how coinsurance works; 52 percent understand what a co-pay is; and 42 percent have an understanding of what an out-of-pocket maximum is.

There’s no denying that there’s a connection between employee health care literacy and increasing costs to employers. Employees feel better about their benefit plans and use them correctly when they fully understand the details of their coverage. They are also able to stay healthier, avoid unnecessary trips to the emergency room, and better manage their chronic conditions.

At WGAT, we build relationships and establish trust with our plan participants, providing on-site support and health benefits education. All WGAT plan participants have access to our bilingual team of field service representatives. The role of our on-site representatives is to elevate and empower plan participants and assist them with any questions they may have regarding open enrollment, explanation of benefits, claims, and more. We also make onsite educational visits to promote healthy behaviors and help lower the risk of chronic diseases and other health conditions.

What are other ways employers can fix the problem and help their employees understand and make the most of their health plans? Let’s name a few.

  • Make a list of in-network providers. Additionally, you should make sure you keep a list readily available upon request. Educate employees on how to find and use providers who are in-network, and how they can find a provider in instances when they’re out of town. WGAT partners with Anthem, which offers some of the best negotiated rates. This means employees pay less for claims. If clients have employees or dependents outside of California or Arizona or are traveling outside of these states, they are still covered. They will have health care coverage through the First Health Network for non-emergency care. This will help mitigate out-of-network claims and higher out-of-pocket costs.
     
  • Remind employees that in non-life threatening situations, they can use Urgent Care or telehealth services instead of going to the emergency room. Emergency room visits can become extremely costly and, in many instances, can be avoided completely. If an employee can’t get to a doctor or aren’t sure if they need to go—and if it’s not an emergency—they should make an appointment with their physician. Plus, it’s important for them to build a relationship with their family doctor or specialist so they’ll have someone they know and trust. For members of WGAT, telemedicine program Doctor on Demand is available for all plan participants. This program is an added benefit to their health plan and is less expensive than a normal doctor’s visit. WGAT also operates Cedar Health and Wellness Centers for the communities in Salinas, Watsonville, Santa Maria and Oxnard. These centers provide general and family practice services (primary care and preventive services) in rural areas at a low cost. The clinics offer deep discounts for regular office visits and convenient access to prescription medications. Bilingual providers and extended hours are available to accommodate the needs of the workforce.
     
  • Remind employees of the availability of any possible Care Management programs for chronic conditions and wellness services. Productivity losses from missed work due to poor health care and preventable chronic conditions cost employers $225.8 billion, or $1,685 per employee, each year, according to the Centers for Disease Control and Prevention (CDC). All WGAT plans have access to our Pinnacle Health Management program. Conditions offered under the program include asthma, diabetes, hypertension, hyperlipidemia (high cholesterol), weight management and depression. Our add-on programs include a Mom-to-Be Program, which supports expectant moms during pregnancy, delivery and post-natal care, and our Nicotine Cessation Program to assist participants in ending their nicotine dependence. These programs include educational and support materials and monthly coaching sessions from a health care professional.
     
  • Talk about benefits outside of open enrollment. Health care isn’t a once-a-year thing—it’s something that happens year-round. Employees will get sick, and in some instances, bigger issues will arise. By keeping benefits information readily available and in everyone’s mind, employees will make better decisions if there’s an illness or condition that needs to be addressed.
     
  • Communicate the availability of additional tools. Most employees are surprised to learn about additional tools, such as discounts or services that are available through their health plan. If you have an online portal, make sure your employees receive the necessary training so they can navigate it without any problems. For members who have a WGAT plan, they have access to our Healthview portal, which enables them to look up available providers, check their claims status, verify deductible and out-of-pocket maximums, request replacement ID cards, and more.

In addition to these tips, remember that if you have the WGAT plan, your Western Growers Insurance Services account manager can assist you as needed. If you don’t have the WGAT plan but want more information or are interested in purchasing the plan, contact a WGAT sales representative at (800) 333-4WGA.

 

WG Staff Contact

David Zanze
Executive Vice President, WGAT; President, Pinnacle Claims Management, Inc.

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