Employee Education

Why is Employee Education
so important?

We recognize plan selection and technology are important, however both are pointless if employees do not understand and appreciate their company’s comprehensive benefits package.

Our team strives to educate and engage their employees to heighten satisfaction with not only the benefits package but also with their employer.

How do we educate?

The Safegard Group will coordinate & facilitate educational employee open enrollment meetings. Recorded webinars are available for people who are unable to attend the meeting (employees/spouses/new hires).

Open enrollment is a period of time each year when employers permit new employees to enroll in a health plan and allow current employees to make changes to their existing medical coverage. During open enrollment, employees may decide to change plans, add or drop a dependent or add an optional benefit, such as a dental plan. Employers can assist employees during open enrollment by distributing materials that explain new health options and changes to existing benefits.

To help employees select the plan option that best meets their needs, employers should provide information about the following:

  • A general summary of what benefits are covered by the plan
  • Limits on coverage, as well as limits on coverage for certain conditions
  • Coverage for preventive services, procedures and medications
  • Prescription drug coverage details
  • Cost-sharing (e.g., premium contribution, deductible, copayment or coinsurance requirements)
  • Consumer directed and high deductible health plans or other non-traditional plan types

The following are ways for employers to improve their open enrollment communication strategies:

  • Communicate frequently with employees regarding their health coverage options, but avoid overwhelming employees with information. Give them ample time to absorb new information, ask questions and express concerns.
  • Use simple terms to explain changes.
  • Thoroughly explain the goals and rationale of health care benefits to managers and business leaders so they can effectively explain health plans to employees.
  • Be ready to answer questions and face challenges from employees regarding changes.
  • Be honest and direct when discussing health benefits, especially if employees are facing cost increases for their coverage.
  • Discuss the “Five Cs” of enrollment with employees: Cost, coverage information, changes to plans, comparisons to last year’s plans and current options.
  • Provide information to employees about the health care providers or networks that will be available to them in new or revised plan options.
  • Provide testimonials from other employees about their experiences with changes in health care coverage.
  • Use a variety of communication methods, such as the Internet, printed materials and face-to-face discussions.

Some groups of employees may need additional assistance, particularly those with mental or physical disabilities, low or fixed incomes, parents of children with special needs and non-English speakers. Without special assistance, these groups may miss open enrollment periods or have large gaps in their coverage.

Properly Educating

The Safegard Group provide companies with ongoing educational material to reinforce understanding, correct usage of offered plans, and ensure company compliance with required documentation.

Employers are responsible for educating their employees about the health coverage options they offer. Employees have the right to receive clearly presented health and benefit information and assistance reading health materials, if needed.

More specifically, employers are responsible for informing employees of:

  • What benefits are covered in the offered health plan(s)
  • Cost-sharing requirements and arrangements
  • Procedures for resolving complaints and appealing decisions
  • Licensure, certification and accreditation status
  • Methods for measuring consumer quality and satisfaction
  • Composition of the provider network
  • Obtaining referrals to specialists
  • Cost of emergency care services
  • Price, quality and safety of health benefits provided by the offered plans

Required Documents

The Employee Retirement and Income Security Act (ERISA) requires health plan administrators to give plan participants specific information about the benefits to which they are entitled, including covered benefits, plan rules, financial information, and documents about the plan’s operation and management. This information must be provided in writing on a regular basis or upon request.

There are certain materials that a plan sponsor must provide to each participant and beneficiary in a plan, even if not requested:

  • Summary plan description
  • Summary of material modifications (whenever the plan is amended)
  • Summary annual report (contains information on the financial condition of the plan)
  • Summary of Benefits and Coverage

These materials can be provided electronically, as long as certain requirements are met, including the requirement that the plan member gave consent to receive the documents electronically.

Summary Plan Description

One important document that participants are legally entitled to receive automatically is a plan summary or summary plan description (SPD). Generally, SPDs contain the following:

  • Outline health care services covered under the plan
  • Describe how services are provided and how the plan operates
  • Describe how benefits are calculated
  • Explain the portion of costs for which the plan is responsible, and the portion of costs for which the participant (or beneficiary) is responsible (for example, copayments or coinsurance)

ERISA specifically requires that SPDs include the following types of information:

  • Cost-sharing provisions, including premiums, deductibles, and coinsurance or copayment amounts
  • Annual or lifetime caps or other limits on covered benefits
  • The extent to which preventive services are covered under the plan
  • Whether, and under what circumstances, existing and new drugs are covered under the plan
  • Whether, and under what circumstances, coverage is provided for medical tests, devices and procedures
  • Provisions governing the use of network providers, the composition of provider networks and whether, and under what circumstances, coverage is provided for out-of-network services
  • Conditions or limits on the selection of primary care or specialty providers

Other Required Communications

Employers are required to provide the following documents to participants upon written request:

  • Updated SPD
  • Terminal report
  • Summary annual report
  • Copy of any relevant collective bargaining agreement(s)

Also, employers must make certain documents available for inspection by plan participants and beneficiaries:

  • Plan description
  • Latest summary annual report
  • Plan document

The Safegard Group will train employees on our benefit administration technology and available insurance carrier tools enabling them to become better healthcare consumers.

For benefits administration we utilize BerniePortal, a highly customization benefits administration platform that that meets the needs of employers of all sizes. Learn more about it below!

BerniePortal Features

Benefits

Provide employees “at-their-fingertips”
access to a year-round portal

Onboarding

Simplify on boarding with online W-4s,
W-9s, I-9s, and customizable forms

Integrations

Integrate with leading insurance
and payroll providers

PTO Tracking

Tracking time off is a breeze with
everything stored online

1094-C / 1095-C

Stay compliant with reporting &
filing directly to the IRS

Time & Attendance

Optimize time tracking and
time off management

iPhone App

Access important HR information
from your iOS device

Billing

Generate carrier bills directly
from BerniePortal

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