Employees Give Themselves Low Benefit Knowledge Grades

October 3, 2003 (PLANSPONSOR.com) - Health-care costs are on the rise and in the season of open enrollment, few American workers are passing the benefit knowledge test with flying colors.

In fact, 43% of the estimated 162 million workers covered under an employer’s health care plan give themselves a “C” or lower grade on their knowledge of health-care benefits, according to a survey conducted by CIGNA HealthCare.

“A health-care benefits plan is something that many people don’t really think about until they have to use it,” said Andrea Gelzer, a doctor and vice president of health policy at CIGNA HealthCare. “But at a time when costs are increasing, it’s more important than ever for consumers to know the details of their plan ahead of time, know how to use it, and know how to get the best value out of their health plan.”

Faced with a lack of understanding, most people then turn to their pocketbooks to do the talking with 83% saying that a plan’s affordability is a very important consideration. Further illustrating this point was that consumers are beginning to take action to help rein in their health-care costs, with more than four in 10 Americans saying they would use more generic drugs as a way to keep costs down. Other cost saving measures included the 37% who said they would take better care of themselves so they would not have to go to the doctor.

“Ultimately it is the member’s choice, but if the member can save money without sacrificing quality of care, many will choose to save money with generics,” said Jon Maesner, vice president, pharmacy strategy & policy for CIGNA Pharmacy Management.

Added Services

Combining costs, generic drugs and a desire to see the doctor less, it is not surprising that other considerations workers ranked as important when choosing their health plan included prescription drug coverage (75%), followed by the inclusion of their doctor in the plan’s network (61%). However, CIGNA points to these decisionmaking items to show that few workers know to ask about other services that may vary significantly from plan to plan and ultimately can have a real impact on out-of-pocket health-care expenses.

When some of the other services were laid out, though, most workers polled said such offerings would be an important consideration in their selection of a health plan. Included in that list was 24-hour phone access to nurses, which seven out of 10 said would be important, but more than half (53%) either do not have it or are not sure if this resource is available to them.

Similarly high interest was given by the 71% that said a nurse case manager would be important; almost the same number (70%) that said it is either not available or are not sure if this is available to them. Additionally, 61% were interested in personalized health resources, even if 44% were unclear if these programs were available.

In the interest of saving money through prevention, high levels of interest were also detected for discounts on health, fitness and wellness services (67%) and disease management programs (79%). However, as with other services, similar high levels of uncertainty surrounded their availability (65% and 57%, respectively).

This all paled in comparison to the 94% who said a wide range of health services – such as mental health, substance abuse benefits, dental and vision coverage – available in one place from their health plan would important. Even with such high marks though, 22% were not sure of this programs availability.

“What the survey tells us is clear – many still think their health plans only process bills and pay claims,” said Gelzer. “But many health plans also offer resources to help consumers make more informed health care decisions. If more people knew about the resources available to them that would help them save money, they would be more inclined to use them.”