Employees Confused About Health Coverage

Armen Hareyan's picture
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According to a recent Guardian survey, women (58%) were more likely than men (47%) to find paying for healthcare premiums and out of pocket costs a challenge. But women (51%) are more likely than men (42%) to have done some retirement healthcare planning.

Gender seems to play a role in the perceptions about paying for healthcare, but employees of both sexes generally do not understand their healthcare coverage. Education and region are also factors that play a role in viewpoints about paying for and understanding healthcare.

The Guardian Life Insurance Company of America, a leading provider of employee and voluntary benefits, including group medical plans conducted the survey, Benefits & Behavior: Spotlight on Group Medical to gain insight about consumer viewpoints on health, wellness and medical insurance. This second segment of the study focused on consumer knowledge of health insurance fundamentals and perceptions about the cost of care. The first part of the study, released earlier this year, focused on consumer views about wellness.

Making Dollars and Sense of Healthcare

-- Two-thirds of the employees surveyed said that healthcare plans in general and healthcare coverage and benefits are difficult to understand.

-- 65% of respondents without a college education said their healthcare expenses were a substantial or great challenge compared to 40% of those with a college degree.

-- More than 1 in 5 respondents did not fill a prescription because of the cost involved.

-- Less than 50% of Boomers are currently planning or believe they are fully prepared financially for their healthcare in retirement.

Respondents living in the North Central and Southern regions saw paying for healthcare as more of a challenge than those in the West.

Paying for healthcare is a substantial/great challenge

-- 59% North Central

-- 56% South

-- 50% Northeast

-- 40% West

Employees don't fully understand some of the basic health care alphabet such as FSA (flexible spending account), HSA (health savings account) and HRA (health reimbursement account).

-- Just over half of employees are aware of flexible spending accounts and health savings accounts in contrasts to four in ten aware of health reimbursement accounts.

-- While two-thirds of those aware of FSAs and HSAs believe they can explain those plans to a co-worker, only about half of the respondents aware of HRAs feel they could do so.

"As women continue to make strides in the workforce and gain earning parity with men this may help to lessen the gender discrepancy we see with paying for healthcare," said Tim Bireley, vice president, Group Medical, Guardian. "Guardian is committed to working with small and midsize business owners to help mitigate the impact of health care inflation and to help employers offer high-quality affordable health care benefits to their employees."

Guardian recently launched a program -- Guardian Premium Protect(SM) -- to help business owners with 51 to 150 employees lock-in health care rates for two years to avoid double-digit premium increases. The program involves predictable employee cost sharing and empowers employers to pass premium savings down to employees by setting up health reimbursement accounts.

Guardian's health plan includes a pharmacy benefit management program to help reduce the costs of prescription drugs for small and midsize business owners and their employees.

Added Bireley, "The need and opportunity to educate consumers transcend gender. A 2006 Guardian study revealed that employees spend less time reviewing their benefits than they do holiday shopping. It isn't enough for insurers and benefit decision makers to develop products and provide educational brochures. We have to make sure that employees are fully absorbing information. We have to consistently surround the consumer and share information with them at several touch points until they have a solid understanding of their healthcare benefits."

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Burgers, Cigarettes, Pills and Lawsuits

Respondents shared their viewpoints about key contributors to medical inflation and identified profits from pharmaceutical companies as the top cause for healthcare costs. Collectively employees recognized their own behavior as a key factor in the mounting cost of healthcare and expressed interest in taking more control over their health to reduce medical expenses.

Factor most responsible for increasing costs of healthcare

-- Profits of drug companies (28%)

-- Lawsuits against physicians (14%)

-- Physician fees and salaries (9%)

-- Poor health of the population (10%)

-- Obesity (9%)

-- Aging population (9%)

-- Cost of prescriptions (8%)

-- Smoking (5%)

Population factors in total

-- Poor health, obesity, aging and smoking (33%)

-- Two-thirds of all employees and 85% of those who are currently enrolled or have participated in a wellness program in the past three years say that these programs are very effective in promoting good health.

"Guardian is focused on helping small and midsize business owners and their employees lead healthier and happier lives," Susan O'Connor, assistant vice president, Group Medical. "We have wellness programs embedded in our health plans such as our complementary alternative medicine and gym membership discounts. These programs are especially valuable to companies with 2 to 150 employees because smaller establishments don't always have resources for an onsite gym or a company nurse."

Mandatory Healthcare -- Size Matters

Employees hold larger companies to a higher standard with regard to mandatory health insurance coverage. Employees believe companies should be required to provide health insurance if they have:

-- <50 employees (53%)

-- 50-99 employees (67%)

-- 100-1000 employees (76%)

-- >1000 employees (79%)

"There is no panacea for some of the challenges that we face, but educating and empowering employees, particularly at smaller companies, are critical to the success of our healthcare system," said Kerri Mansberg, Second Vice President, Group Medical, "Guardian's focus on small and midsize companies is important because attention is often given to larger enterprises. According to the U.S. Department of Commerce, small firms (1 to 500 employees) represent more than 99% of all employer firms and employ about half of the private sector workforce. It is time for health plans to cater to this vital market."

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