- Key insight: Here's why rising employee premium contributions are driving a push for personalized benefit guidance.
- Expert quote: "Decisions are complicated, and they're very important..." — Ramy Tadros, MetLife
- Supporting data: 35% regret the benefit choices they made last open enrollment, according to Selerix.
Source: Bullets generated by AI with editorial review
As
Average annual premiums for 2025
Employees choosing the wrong plan, or not selecting the right combination of available benefits, is costly on the employer and employee end — and something
"Having personalized guidance and advice for individuals can allow them to figure out how to navigate this," he said. "It gets to understanding [their] own personal situation … what [their] employer offers, and then figuring out a way to square that circle."
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Getting a full financial picture
By learning about employees' individual situations beyond just their health, benefits experts — whether internal or a third party — can assist them in "figuring out where [their] premium dollars can take them further from a protection perspective," Tadros explained.
"I need to know [them] — demographics, family, income, savings," he said. "I need to know [their] employer and what benefits they offer, [and with their] permission, I'd like to understand if [they] have any medical procedures planned and how [they're] using [their] existing medical plan. Then I can help provide a very specific recommendation that looks at the constellation of products and find a way to at least put a dent in that medical inflation that they're seeing in their premium."
He cited an example of options he might suggest for a young, healthy employee: "What [they] need is more of a supplemental health plan — it's really the extreme that [they] want to get insured against, [such as] an accident or cancer diagnosis, which for younger people is going up pretty significantly. So [they don't need to] buy the more expensive medical plan; buy a potentially higher-deductible, less rich medical plan, but buy the protection for supplemental health."
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More ways to boost savings
For further cost savings that directly benefit employers and employees, Tadros recommends guiding workers toward providers with a record of preventive care and proven positive outcomes.
Citing dental care as an example, he said, "We see in our data that certain dentists practice dentistry that is more defensive, more preventative. Their procedures are higher quality, so you see less repeat work. That's backed by studies utilization data — we see them doing 20% higher preventative care procedures … 45% lower restorative treatment procedures, and our data says there's about a 17% reduction in net benefits paid on average per member. Those are big dollars, and for an employer that's self-funded, that gives them a savings they can apply to major medical. For an employer that has a contributory or has an employee paid [structure], they can then at least pass on some of those savings to again offset what's going on in the major medical world."
Specialty care benefits for serious conditions is also an area for potential savings and better outcomes when personalization is applied, Tadros said.
"We are looking at highly curated cancer benefit services," he said. "We've got teams of researchers — Ph.D.s, clinicians — people who are staying abreast of medical research and new new drugs that would essentially point you to the person best equipped to deal with your diagnosis, and then walk you through all of that across the entire journey. We're putting this in our critical illness benefit [which means] if you get the diagnosis, we're not just going to cut you a check. We're going to … [also] give you a very tailored concierge experience, and what we're finding is, not only does it help the individual and their family, [but there's] evidence that … it has a very positive ROI on the employer's medical spend. When you build [plans] for the individual with more care and more expert advice behind them, you can get better outcomes at a lower price point."
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Tadros notes that the growing availability of data and advancements in technology are making it easier for benefit leaders and their vendor partners to provide more personalized planning assistance. But while tech tools are becoming table stakes for easy access to information, some subjects still require human touch, he said.
"[Benefit] decisions are complicated, and they're very important, especially in a world where there's more uncertainty and people feel less confident," Tadros said. "The need for [smart choices] has been heightened, and the technology available [can help] give tailored advice at scale. [But] … when it comes to our absence and disability benefits [for example], it's deeply personal. You're trying to navigate a very complex set of issues and understand what your employer offers, etc. We believe those things ultimately are very high-touch, and empathy and human connection are a big part of the value-add that people are seeking at that point in time."
When employees have access to expert guidance and personalized benefit options, their health and financial confidence improve, as does their appreciation for the employer making it possible, Tadros explained. When it comes to benefits selection, "people shouldn't feel confused about these kinds of choices, and they should also come out of them well protected," he said.
