2021 Trends in Open Enrollment

Decision support is a top focus, and lessons learned from the pandemic are influencing this year’s season as well.

The 2020 benefits open enrollment season was like no other, thanks to the COVID-19 pandemic, and plan sponsors learned some lessons from last year they will likely carry forward to this open enrollment season.

James Bernstein, a partner in Mercer’s U.S. Health and Benefits practice, says many employers are aspiring to use a hybrid approach for open enrollment, providing in-person as well as virtual education and events. Depending on the employer’s policies about returning to the workplace and the logistics of its workforce, in-person events and education can still be challenging, he adds.

For employers that have multiple sites in the U.S., aside from the usual challenges of holding in-person events, each location might have different policies about returning to the workplace, Bernstein explains. “We’re finding that some employers are trying to plan as much as possible with the assumption that virtual communication is going to be critical,” he says.

Employers are showing an interest in virtual benefit fairs that are similar to an in-person experience, Bernstein notes. And, an advantage of a virtual benefit fair is that spouses can be included.

“There was an explosion of the use of virtual benefit fairs a year ago and the trend is continuing,” he says. “They’re available 24/7 to employees and spouses. Employees can go into the site and click on different ‘booths’ where they will find videos, information on benefits and Q&As. They can do it on their own time while still getting information in an engaging way.”

Kim Buckey, vice president, client services, at DirectPath LLC, says many employers that have employees at the workplace are avoiding large group meetings, as people still might feel uncomfortable in bigger settings.

She says DirectPath is seeing a lot of interest in dedicated benefit sites that include not only enrollment information but everything employees need, including education materials, forms and information about the process, checklists, and links to other resources that can help them make decisions about which benefits to choose and how to use them. She notes there has been an increase in the use of decision-support tools and people and that she’s also seen a “gigantic” uptick in the use of virtual benefit fairs.

“The fairs include chat functions by which employees can ask questions of benefits specialists in real time,” Buckey says. “Employers are also offering benefit educators. Employees can do their homework ahead of time and meet with an educator to help with decisions.”

Brian Colburn, senior vice president, corporate development and strategy, Alegeus, says he thinks employers will build off some of the digital strategies they rushed to put into place last year out of necessity that have proven to be effective. These include plan selection tools, digital assets and virtual training. “Given that we don’t know yet what’s going to happen with the continuing pandemic and the Delta variant, employers should prepare to operate remotely through open enrollment again,” he says.

Filling Gaps in Benefits

According to Mercer’s 2020 “National Survey of Employer-Sponsored Health Plans,” fielded from July through September 2020 among 1,812 employers, after years of little growth, the use of telemedicine jumped in first half of last year. A large majority of employers (80%) said virtual health care will play a bigger role in their programs going forward.

For 2021, employers are prioritizing employee support, especially for mental health. Despite the troubled economy, few employers planned to cut health benefits in 2021 as way to reduce spending. Only 12% of employers said they would shift cost to employees in 2021, while 36% planned to add new benefits or resources to support employees. The survey shows that behavioral health is the top priority for 2021 for large employers.

Regarding communicating with and helping employees, Bernstein says there are two themes: Employers are communicating about what is changing and what is new, as well as what resources are offered, and they’re providing decision-support tools to help employees determine the right benefits for their unique situations. He says the communications include little bites of information that employees can capture quickly.

“Employers are communicating early via the company intranet, newsletters and emails,” Bernstein says. “There are new and changing benefit options employees need to know about, as we’re seeing so many employers evaluating where there are gaps in benefits, partly informed by the experience of the pandemic. Telemedicine, mental health and child care support are top areas.”

According to Mercer’s survey, nearly one-quarter (23%) of all large employers said they will add or expand their voluntary benefit offerings in 2021. These include supplemental health insurance, such as cancer or critical illness insurance and hospital indemnity plans, as well as coverage to protect employees from a variety of unexpected expenses, such as pet insurance.

Nearly one-fourth (23%) of those with 5,000 or more employees will add new targeted health solutions—typically with a digital component—in 2021 to help employees better manage health conditions on their own or help them improve their health habits.

Buckey says there is an increasing realization among employers that benefits are complicated for employees. Few employees understand what they need to know, and with increases in voluntary and supplemental benefit offerings, it’s even more complicated, she says.

“If employers make an investment in benefits, they want to see a return on their investment,” Buckey says. “They don’t want to put something out there employees don’t use, so employees need to be educated.”

Decision Support

Decision support is being addressed in a couple of ways, Bernstein says. Service providers have technology that offers plan comparisons or point solutions that can help employees make decisions. For example, an employee answers questions about his situation, how he’s used benefits in the past and his health conditions, and the technology will navigate him to the company plan that would be the right fit.

Employers are also considering offering one-on-one connections, such as via health concierge vendors. With this decision-support solution, employees will have a dedicated resource to call for a one-on-one 20- to 30-minute discussion during which all benefits are explained and employees get help selecting the right fit.

A hot topic right now is cost transparency information, according to Buckey. “There have been news reports about hospitals that are not in compliance with regulations requiring them to be transparent about prices, and over the next three years employers with self-funded health plans will see similar requirements for them,” she explains.

To help with that, employers are offering tools to inform employees about where to receive good care and how much it will cost them.

“They are educating employees that they can shop around for care,” Buckey says. “Employers should educate employees about how their health care choices can affect their wallets.”

She notes that the No Surprises Act, a part of the Consolidated Appropriations Act, 2021, takes effect in January and could change how out-of-network services are covered and claims are processed.

“Even if an employee did his due diligence, there can be surprises,” Buckey explains. “For example, they could see an in-network specialist and have to have surgery, then get a bill from the anesthetist, who is an out-of-network provider.”

Employers are providing ongoing support as part of their benefits, offering advocacy and transparency services to help employees navigate the differences in prices between hospitals or providers.

According to Mercer’s survey, more than a third of all large employers offer a health navigator service, either a by telephone (29%) or through an artificial intelligence (AI)-powered digital service (6%), to help employees find the right provider and offer assistance during episodes of care, and another 16% are considering it.

Colburn says most people, in all stages of life, tend to choose the wrong health plans because they don’t understand their choices. Alegeus’ 2021 “Post-Open Enrollment Survey” found that nearly half (48%) of employees said their employer did not provide them with enough educational resources to prepare them for enrollment decisions.

“As a result, employees are struggling to make the right benefit enrollment decisions, with nearly two-thirds simply re-enrolling in the same plan as the previous year,” Colburn says. “It’s extremely important for employers or HR [human resources] departments to provide resources—printed assets, digital tools, virtual courses—so that if an employee isn’t comfortable speaking directly to someone in the HR department, they have these to guide them to a more informed decision.”