Learn to Explain Health Insurance to Anyone and Everyone

faces of multiple expressions

The conversation about the first open enrollment for the federal health insurance exchange is changing. From one focusing on a bum website and "cancelled" policies to who did and did not enroll in a health plan. It will take some time before we get the answer to the who enrolled question, but I am glad it is being asked. But not for the reasons some are asking it.

You see I don't care about the race or income of the enrollees. I care that people who took the time and paid the expense to obtain coverage get the most out of it. I didn't always feel this way. When I began my employee benefits career, I assumed that anyone who enrolled in a health plan understood how to use it. I was wrong. And I am so glad I learned that lesson because it is easy to go through your entire career not knowing that private health insurance is a foreign concept to millions of Americans.

This is the story of how I learned that valuable lesson.

The employee, I'll call him Jimmy, was colorful to say the least. He was a guy with a lot of personality and he really
loved to talk. Fortunately, I was one of his favorite people to talk to. And I do feel fortunate to have known him because of the lessons his life taught me. And, I genuinely liked him.

Jimmy spent many years of his adult life in prison and had recently been released before being hired by our company. He was hired one month before I joined the company. About one week into my new job I got a visit from my department head who got a visit from her boss asking if the new girl (me) could explain how a private health insurance plan works to Jimmy. He had complained to this senior manager that his wife was turned away from the health clinic they used when she showed them her new medical ID card.

Assisting the Never Hads

Most young new hires never had private health insurance under their own name, but did under a parent or guardian. I don
t include them in my definition of Never Hads. Back to my story.

Before enrolling in our company's health plan, Jimmy received health care from two different sources--his local free clinic or the prison health system. He did not have to pay a premium, deductible, coinsurance or copay to receive health care. And he did not have to choose a doctor. He bypassed the insurance process and went straight to the health care receiving process.

How do you explain this extra process to someone who never had any kind of insurance (homeowners, auto, life or health)?

Don't Explain, Do

Ten minutes into my first meeting with Jimmy, I felt challenged to come up with a completely new way of explaining health insurance. The conversation was vastly different from the conversations I typically had with new health plan enrollees. I was not use to telling people what they could or could not do with their health insurance. I saw my job as providing general information about the plan and it was up to them to figure out the mechanics of using it. I never once thought that someone would not know how to take the first step in using their coverage.

So, this is what I did:

I asked Jimmy if his wife could join our conversation, and with his consent, I called her. She informed me that she went to the free clinic and showed them her new ID card that our plan issued and was told that she would not be treated. I told her that was correct because the private insurance Jimmy purchases through the company replaces the free, public care they once received. No more free clinics. I told them that the care they once received at no cost would now mean money out of their pockets, in addition to what we subtracted from Jimmy's paycheck. I also told them that based on Jimmy's income that they were not eligible for Medicaid, but her son from a previous marriage was likely able to get free health coverage under the state Children's Health Insurance Program (CHIP). I printed a CHIP application and we filled it out right there in my office. I told Jimmy to give it to his wife to sign and mail. I also gave them a stamped envelope with the address of the CHIP office. The next thing I did was help Jimmy and his wife find a doctor near their home and schedule an appointment. Lastly, I found a state based premium support program that they could enroll in that would help them pay part of the cost for the medical plan premiums. These programs help the working poor afford health insurance. I helped them complete and submit the application.

How was I able to do this? I did a lot of research.

Knowing Jimmy and his wife had never had private insurance, I became familiar with the public options they may have used like free clinics, Medicaid, CHIP, and other premium assistance programs for unemployed or low wage workers. This knowledge has allowed me to help many employees in circumstances similar to Jimmy. I have assisted numerous employees in applying for CHIP coverage for their children and premium support programs.

This situation with Jimmy and his wife changed the way I approached my job. It made me become more research focused; looking beyond the benefits the firm I was working for offered. It gave me a broader view. And when I think about the Affordable Care Act bringing a lot more
Never Hads to the private health insurance table, I am concerned about how they will be introduced to this new world. There are many employees like Jimmy in every workplace. Benefit professionals should learn how to meet the special needs of people who never received medical care, never had private health insurance, or come from a country that did not have private health insurance.

How are you meeting the needs of employees who never had private health insurance?
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