November 2021

Making the Most of Open Enrollment During the Pandemic

11/2/2021 9:56:14 AM

Making the Most of Open Enrollment During the Pandemic:
Best Practices Designed to Benefit Your Clients, Their Members and Their Health Plan

By Scott Geyer, Senior Vice President, Client Relations

At best, open enrollment is challenging in normal times for all parties involved, employer plan sponsors and their members/employees. But these are not normal times. The pandemic has magnified the importance of helping members understand their benefits, so they select the most appropriate coverage to meet their specific needs. Working with hundreds of clients across the country, my team is seeing some definite trends developing as employers begin open enrollment. 

Hybrid approaches to benefit fairs and information sessions
As the full impact of COVID-19 emerged in 2020, companies quickly turned traditional in-person benefits information meetings and benefit fairs into virtual events. While the success of these events varied greatly among employer groups, most successfully navigated through the 2020 open enrollment period. In 2021, companies are beginning to gradually return to face-to-face benefits information sessions, although nowhere near 2019 levels. Teams from HR and Benefits are meeting with limited numbers of employees at designated times. The opportunity to answer questions in-person is especially important as the focus by employees on voluntary benefits is intensifying.

Voluntary benefits take the spotlight as employees face post-pandemic realities
Much has been written about the pandemic’s toll on worker’s mental health. We are already seeing ramped up promotion of behavioral health benefits and EAP services. Our partner, Teladoc, has expanded its offering  and has seen significant utilization in this area. We’re also seeing more companies focusing on critical care benefits, cancer benefits and even pet insurance. This bigger focus on voluntary products is undoubtedly a direct result of the pandemic. 

Discouraging automatic renewal while encouraging careful consideration of the right benefits for you and your family
Every year, a majority of enrolling employees takes the easy way out and checks the “renew my benefits with no changes” box. While passive enrollment is the fastest way to complete the process, employers are encouraging their employees to evaluate their current financial and personal situations before choosing their benefits for 2022. Ask yourself, are the benefits I had five years ago the benefits I need today? Probably not. Aging and changes in family circumstances often require updating benefits choices. 

New technologies are supporting the enrollment process and benefits decisions
Open enrollment is now available via cell phones or other mobile devices through apps. Some employers are using plan selector technology to help individuals decide on the best coverage for him or her. By answering a few questions – how many doctor office visits do you anticipate having in the next year, how many prescriptions are you likely to fill, how much do you anticipate paying out-of-pocket – the selector recommends the coverage that best meets your needs. While artificial intelligence (AI) is being used in other ways to support employees’ benefits choices, because health care is tricky and complicated, I don’t anticipate it will ever play a dominant role in the open enrollment process. 

Expanding provider networks limit out-of-network costs vs narrowing the network
When it comes to your PPO network decision there are two main choices, broad network or narrow network  While employers continue to design health insurance plans and benefit plans that incentivize enrollees to use in-network providers and facilities, the choice to offer a broader PPO network assists employees in minimizing their out-of-network utilization and therefore reducing their out of pocket expenses.  

A narrow network under a Referenced Base Pricing  (RBP) plan accomplishes the same benefit to member but takes away some of the choices members have in which facilities they can utilize under a broader network. It’s important to consider the impact to your workforce and employees when considering an RBP option.  This approach limits disruption by directing care to fair-price facilities.

Telehealth is here to stay
While most insurance plans offered limited telehealth services pre-pandemic, the need to stay home and socially distance created an immediate uptick in telehealth utilization and acceptance. Employers have found telehealth services to be less costly than traditional in-office visits. They have also discovered that what used to cost employees three to four hours of PTO for doctor visits can now be accomplished over the lunch hour in about 15 minutes, so productivity and employee satisfaction are higher. Telehealth technologies are also advancing, with in-home virtual wellness exams just around the corner. The end result will be those who really need to have an in-office visit will be able to schedule the visit quicker. 

Reducing pharmacy spend is squarely in the cross hairs of most employer sponsored plans
The cost of medications is still a top concern for employers and their covered employees. Specialty medications have driven spiraling pharmacy costs. The pandemic has created a backlog of specialty drugs awaiting final FDA approval, so a tsunami of specialty drugs is expected to hit the market in the coming months. HealthSmart is working with our clients to expand the use of our Copay Maximizer services. This service not only matches available manufacturer discounts on the pharmacy side, it also evaluates opportunities to take advantage of existing discounts on the medical side as well. Most copay assistance programs only address the pharmacy benefit, but almost half of specialty pharmacy spend hits the medical benefit.

Benefits related communication will be a year-around process, not just a once-a-year information dump
Many employers have realized communicating about benefits in a narrow window of time during open enrollment is nothing more than an information dump that overwhelms and confuses employees. That’s why an emerging trend is for employers and their sponsored health plans to conduct year-around communications focusing on one benefit at a time. 

We are also seeing employers who introduce additional or enhanced benefits, especially voluntary products or services, implementing those off-cycle, so they don’t get lost in the crush of enrolling in the other standard benefits. 

In the post-COVID world, employees are motivated to make smart benefits elections. Helping them make those decisions requires a combination of ongoing communication, technology supported applications, expansion of telehealth services, clearly and concisely explaining the available menu of voluntary benefits and using hybrid approaches to provide health information sessions and benefits fairs. 

Scott Geyer was named Senior Vice President of Client Services for HealthSmart in 2019, with overall responsibility for HealthSmart client relationships.

Scott’s entire career has been focused on client service, beginning in 1997 with Wells Fargo Insurance Services as a customer account manager, claims supervisor and account executive. He had 15 years of service with Wells Fargo when it was acquired by HealthSmart in 2012. He continued his role with HealthSmart as account executive, soon being promoted to senior account executive, Vice President of Client Services, and most recently, Senior Vice President of Client Services. In all, Scott has been serving our customers for more than 23 years. 

Scott holds a Bachelor’s degree in Social Science from the University of Charleston.