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. Continue Reading...

Tags: communication, education

Setting up employee benefits plans requires the production of a lot of plan materials.  And once these plans go live, the employer must create and maintain multiple plan documents.  This is usually where things start to go wrong.

Types of Employee Benefit Plan Documents

• Insurance Contract or Agreement
• Corporate Resolution (for health plan and retirement plans; authorizes establishment of the plan)
• Summary of Benefits Coverage (SBC) (usually a two to four-page summary of basic plan features and costs)
• Certificate of Coverage (COC) (detailed description of the plan’s benefits; usually provided by the insurer)
• Summary Plan Description (SPD) (usually includes the COC plus the required ERISA language and special notices such as HIPAA Privacy Notice, Medicare Part D Notice of Creditable Coverage, Medicaid and CHIP, Newborn and Mother's Protection Act, Special Enrollment Rights, Women's Health Cancer Rights Act.  Is basically a summary of the plan document meant for employee consumption)
• Plan Document - (technical document of little use to employees as it is intended to serve as a guide to the plan administrator (employer) in how to carry out the provisions of the plan)

These documents are important from both a legal and employee education perspective.  Employers are required by law to have a SPD and Plan Document for each plan.  Every employee who enrolls in a benefit plan must receive that plan's SPD within 90 days of the enrollment.  In addition, employers must administer their plans in accordance with the terms and conditions outlined in the Plan Document.  The integrity of these documents is the top priority of every employee benefits department.  NOT! Continue Reading...

Tags: legal documents, plan information

Benefits professionals can sometimes feel like the stepchildren of the HR department. Often losing the spotlight to their more “outgoing” colleagues. You know, the recruiters, trainers, and employee relations folks. While we work behind the scenes ensuring our benefit plans comply with tax laws and other regulations, the other HR staff are chatting it up all day. We poke out our heads once a year to host the annual open enrollment; they host monthly supervisor training. Are they nicer than us? Do employees like them more than us? Are they more needed than us? No. Not really.

There are many reasons why benefits professionals are often anonymous at work. Sometimes their anonymity is self-imposed, but sometimes upper management shoves them in this direction.

3 Reasons for Self-Imposed Anonymity

• More comfortable dealing with technical issues than people. (Most pros I know enjoy the technical and people aspects of the job)
• Fear of being bombarded with questions. (Oddly, some benefits pros think that employees should just read the benefits materials and understand them as they do)
• Think their job is to wait for someone to ask them a question. (It's not entirely their fault as new-career pros are never encouraged or taught to offer help in advance of a problem)

Continue Reading...

Tags: communication

Employee benefits professionals routinely assist employees in resolving disputes over denied or improperly paid health insurance claims. Next to the annual open enrollment and benefits fair, these encounters are the most one-on-one contact benefits pros have with employees. Therefore it is extremely important that these interactions are handled with professionalism and understanding.

To make sure that happens create a checklist or guide you can use every time you assist with a claim dispute. You can use an existing checklist like the one from ehow and add to it. For example, include a first step on how to prevent a claim dispute from happening and a final step of filing an appeal with the state department of insurance. You can also share these customized guides with employees, in the form of a brochure, as part of the new hire benefits package, as a newsletter article or on the company website.

Creating a claims dispute resolution guide or checklist is not difficult. Working with an upset and confused employee is. Therefore, it is important to know what to expect and establish some guidelines and expectations for the employee and you.

What to Expect From An Employee Disputing an Insurance Claim

• Expect them to be upset
• Expect them to talk too fast
• Expect them to leave out relevant information
• Expect them to want you to agree with them
• Expect them to want an immediate resolution

Continue Reading...

Tags: health care claims, insurance claim dispute

CEBS stands for Certified Employee Benefits Specialist. It is a prestigious designation, partly because of its association with The Wharton School of the University of Pennsylvania. Adding to its distinguished status is the difficulty in obtaining it. To get the certification you have to pass eight (8) exams covering a variety of topics, including employee benefits, compensation, finance and economics.

According to the CEBS website just over 13,000 people obtained the CEBS certification in its nearly 40 years of existence. That's not much. Which got me thinking recently, why did I invest the time and money getting the CEBS certification? Should I have put the nearly $5,000 I spent in my IRA? For me the answer to that question is "yes". And for employee benefits professionals like me l would suggest they save their time and money.

Why I Say “No” to CEBS

The problem with the CEBS certification is the usage of the words "employee benefits". A better name would be the Certified Financial and Insurance Benefits Specialist or CFIBS. Continue Reading...

Tags: professional certifications, education, training

I'm a natural born giver. If I have the time, resources or knowledge to help someone, I won't hesitate to assist them. You see I don't have any insecurity about helping others succeed. I think if you know how to do something or you know of a resource that will help someone reach their goals, you should tell them about it.

On the flip side, asking for help makes me feel extremely vulnerable. I do seek help occasionally, but it does not come naturally for me and I should probably do it more often. There are two reasons I don't like asking for help. One, I like to figure out things on my own. Two, I've been made to feel like a burden when asking for help in the past. It's a stinging feeling.

Here are my rules for giving and seeking help. Continue Reading...

Tags: networking, relationships