Working with Human Resources for Better Health Care

If your company offers health care benefits, your Human Resources (HR) department can be a big help to you. HR department members can tell you about the open enrollment schedule for choosing or changing your health plan, and accompanying deadlines, and provide information about the types of plans being offered.

Make an appointment to make the most of your HR department's expertise and bring all your questions.

About Your Health Insurance Plan Benefits

Some employers provide benefits automatically to eligible employees, while some require employees to choose their own health plan. Sound decisions about health coverage help keep your costs low, and HR can help.

During open enrollment, you re-evaluate your benefits and decide what to change—or not. Your HR department can offer information about open enrollment dates, tips on how to navigate this process, and names of insurance plan support contacts.

The employer can choose to offer an off-cycle enrollment period that gives you an opportunity for voluntary benefits appropriate for your other needs—not just health insurance or retirement. You, your family, or domestic partner may have access to voluntary benefits such as:

• Dental and vision insurance
• Life insurance
• Disability insurance
• Long-term care insurance

Wellness programs may also be offered, and according to the Society of Human Resources Management, these can include:

• Smoking cessation
• Weight loss
• Stress management
• Company gym/workout rooms
• Company-sponsored sports teams
• Medical screenings
• Immunization/flu shots

Pick Your Plan

A recent Kaiser Family Foundation survey found most companies offering health benefits offer only one type of health plan. Here are some things to know about the most popular types:

• Preferred Provider Organization (PPO) plan. Most employers offer this plan, in which you see any provider who's a member of your insurance plan's network. You can usually see specialists without a referral.
• Health Maintenance Organization (HMO) plan: This plan offers a wide network of health care providers, with care coordinated by your primary care provider (PCP). Usually, specialist visits require a referral from your PCP.
• Exclusive Provider Organization (EPO) plan: Utilize all the providers within your network plan, and that means specialists, too. But don't expect any coverage outside your network.
• High-Deductible Health Plan (HDHP): Just like it sounds, you'll meet that high deductible before coverage kicks in. If you want low monthly premiums and don't expect to use lots of coverage, this may be for you. An HDHP is usually connected to one of the other types of plans listed above, but typically they are PPO’s.

Use Human Resources … As a Resource

Before you choose a plan, ask your HR representative to help answer specific questions about:

• Exactly what is covered and who is covered.
• Status of coverage for working spouses or dependent children.
• Best ways to save on your health care costs.
• Different types based upon your personal circumstances.
• What preventive care is covered.
• The benefits of using doctors in your plan—or not—and what that means to you.
• tax-deferred health care expense accounts such as Health Savings Accounts (HSAs).
• Whether you can make changes once you're enrolled, especially if you have a qualifying life event that may happen outside of open enrollment—like getting married or having a baby.
• Advice on emergency, urgent, maternity and chronic condition care.
• How prescription drug coverage works—
  Your plan may offer three tiers, including:
  • Generic: Less expensive copies of brand-name drugs.
  • Formulary brand: On a preferred drug list.
  • Non-formulary brand: Not as cost-effective, with generic equivalents in the marketplace.
• Whether you’ll have access to telemedicine or remote clinical services can save you money.

Many employers offer info sessions about the upcoming open enrollment period, so take advantage of them. They're a resource, so ask HR for help if you need it. Together, you'll take better care of you.