While 84% of participants in a recent study of high-deductible health plans know their plan includes a deductible (and 70% could correctly name the dollar amount within a 20% range), nearly half of all study participants mistakenly believe that their deductible applied to both preventive and non-preventive office visits and medical tests. Further, The Kaiser Foundation Research Institute study reveals that fewer than one in five participants understand that a preventive office visit is exempt from their deductible, and only one in 10 understand that preventive tests also are exempt.

As more employees enroll in high-deductible health plans, employers must be even more clear and consistent with their health benefits education to ensure participants use the plan as it was intended. If consumers are unaware of their specific health plan details, they may avoid preventive care unnecessarily, leading to more serious health issues and higher costs down the road.

In fact, despite access to free or modest copayments for preventive care as part of their small-group employer’s plan, nearly one in five consumers report that cost concerns has led them to delay or avoid preventive office visits or tests. Those unaware that preventive office visits are exempt from their deductible were significantly more likely to avoid these visits because of cost concerns, according to the study of primary subscribers of Kaiser Permanente Northern California health savings account-eligible high-deductible plans in 2008. The study reveals similar results for participants avoiding medical tests and screenings due to cost concerns.

Even if participants understand that preventive care is free under their HDHP plan, some forego doctor appointments to avoid paying for other non-exempt medical tests or follow-up appointments down the road, explains study coauthor Mary E. Reed, staff scientist at the Kaiser Permanente Northern California Division of Research.

"It comes down to better education," believes WorldatWork Benefits Practice Leader, Lenny Sanicola. "There's a lot of misunderstanding about how these plans work, so I think that we as employers need to do a better job communicating against misconceptions that these plans are for people who are mostly healthy and people with higher income. They can be appropriate for a variety of people," he adds.

"Benefits structures are complicated for everybody," explains Christine Paige, senior vice-president of marketing and Internet services, Kaiser Permanente. Confusion is rife especially when employees aren’t familiar with cost-sharing plans that have deductibles. Health savings accounts add another layer of complexity to the plan.

"It requires quite a bit of support to help employees take full advantage those benefit designs," Paige expands.

While open enrollment is a great time to deliver short, simple pieces of information to attentive employees, employers need to continue educating year-round. For example, once employees elect a plan, an employer can follow-up with what their elections mean for them and what it covers.

Sanicola suggests employers start communicating around the most relevant provisions for participants during and after open enrollment, such as cost, prescriptions, urgent/ER care, and copays/coinsurance amounts for doctor visits.

"I think you need to start with the 'What's in it for me?' approach and build the communication campaign targeted around that [mindset]," he says.

For example, Kaiser Permanente has learned that employees push aside written materials because it feels like homework and the information isn’t relevant at the moment.

"We've learned that 'just-in time' communication is really effective. So rather than sending expensive materials at the point of enrollment, we call them before their first visit to remind them how that might work and we give a targeted call afterwards as well to make sure they know what the next steps will be," Paige says.

Participants continue to improve their understanding of HDHP details as they become more familiar with the benefit design and through health care reform provisions that require all plans to cover recommended preventive services without cost-sharing.

According to a 2011 WorldatWork report, 57% of plan sponsors noted seeing desired changes in employee behavior when it comes to making employees better consumers of benefits programs.

Nevertheless, employers should watch preventive utilization carefully in their workforce because if participants don't understand the details of a complicated health plan, they may not act in the way sponsors expect.

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