We have written before about the myriad of reasons why employers should have a strong benefits package in place. However, in their excitement, employees can sometimes incur unintended personal expenses, either by spending more than their benefits provider allows or by assuming their package covers expenses that it does not.
In this blog we outline steps you can take to help employees:
- Find the best deals available
- Understand what is and is not covered as part of their package
- Know which certifications health care professionals are required to have for reimbursement.
Familiarize Employees With Reasonable and Customary Limits
Reasonable and customary limits are an aspect of benefits offerings that employees and their dependents should be aware of. Essentially, reasonable and customary limits are the maximums that insurance carriers will pay for a particular medical service or product. If the expense exceeds the limit, the carrier will pay up to the maximum based on the plan’s reimbursement schedule, with the rest of the balance left for the employee to pay for themselves. Reasonable and customary limits are essential to preventing excessive charges and in keeping the cost of benefits affordable for everyone.
Insurance companies provide information on what their reasonable and customary limits are to plan members. This information is usually available online via the plan member site or by phoning the insurer directly. Being familiar with these limits empowers employees with the knowledge to determine for themselves whether a service provider is overcharging for their services or if the extra cost is worth the out-of-pocket expense.
Educate Employees on Fee Schedules
When it comes to shopping for products or services covered by a benefits plan, employees rarely apply due diligence to finding the best deal possible. By not paying close attention to cost, employees can spend more out of pocket than they meant (or need) to.
It isn’t as easy to find the best deal on a naturopath or dental exam as it is for a new pair of shoes. Fortunately, tools have been created by benefits providers to make this process smoother.
- Lumino Health, developed by SunLife, is an easy search engine for anyone looking for health and dental service providers. Searches are based on the users location and type of service they’re looking for, and the results show the provider’s 5-star review and whether their prices are less than, at, or above the provincial fee guide.
- Pharmacy Compass, developed by Pacific Blue Cross, uses your location to compare drug and prescription prices of nearby pharmacies. The information includes the distance from your location, the cost per pill, the dispensing fee, and whether it is part of the preferred pharmacy network.
- Suggested Fee Guide, it is important for your employees to be aware that each province has a dental fee guide that is updated annually. Insurance companies must abide by these guides. However, dentists and dental specialists are free to charge any amount.
Therefore, a financially savvy practice is to request a pre-determination for major dental work such as crowns. A pre-determination is an outline of all the procedures and costs that a dentist is planning to charge and the outline is sent to the insurance company prior to work commencing. The insurance company then sends the details of the costs of the planned procedure back to your plan member, itemizing the amounts that the benefit plan will reimburse. By taking this extra step, your employees will know exactly how much the insurance plan will cover and how much they will be out of pocket.
Many other professions including naturopaths, counsellors, and massage therapists have recommended fee schedules which the insurance companies follow—but again, these practitioners are free to charge any amount.
Understand What Services the Benefits Package Covers
Sometimes an employee thinks their benefits provide coverage in areas it does not. For example, though many benefits packages cover a visit to a naturopath, they may not cover the expense of the supplements.
When searching for a specific service, make sure the professional you’re seeing has the credentials required for coverage. For mental health professionals, some plans only cover visits to psychologists. Psychologists are regulated by the college of psychologists and receive the title of R.Psych. Occasionally, employees will book appointments with therapists who are Registered Clinical Counsellors (RCC) believing their visit will be covered by insurance. Unfortunately, RCC’s are generally not covered, though therapists with a Masters of Social Work generally are reimbursed under plans covering counselling services.
There are three key approaches to reduce the number of times employees are surprised with unexpected out-of-pocket expenses. The first includes an initial orientation about the benefit plan and proper benefits usage as part of onboarding. Secondly, employers can offer reminders or updates throughout the year and teach employees how to access the tools provided by the insurance carrier. Finally, employers can foster an environment where employees feel comfortable going to HR with out-of-the-box benefit questions that can be escalated to the plan’s advisor when necessary.
With a little bit of research, employees can avoid surprising out-of-pocket expenses. Remind your employees to double check the reasonable and customary limits and to make sure they understand what is covered as part of their benefits. In doing so, your employees will get the most out of their benefits, and no unwanted surprises will leave employees feeling that you are looking out for their best interest.