When we wrote about how HR can give every employee personalized health plan guidance, we focused on a fundamental challenge with health plan decisions: the right combination of health plans looks different for every household.
The Decision Support Tool (DST) brings an employee's plans, their spouse's plan, their family's healthcare needs, and the Total Care Option (TCO) into a single view. This way households can compare every option side by side.
The information needed to make that decision is usually split between two people. One spouse may know the details of their employer's plans, while the other has access to a different set of benefits information. The DST should make it simpler for both people to contribute what they know and review the decision together.
So we made three improvements to make that easier:
- A better starting point gives employees the context they need to understand the TCO before they start comparing their medical plan options.
- New ways to keep households moving through enrollment give employees more ways to get their spouse's plan into the comparison, even when they don't have the plan document.
- A spouse invite lets employees ask their spouse to provide the plan directly, while the employee can use one of the other options to get an estimate in the meantime.
These improvements make it easier to get both spouses' information into the DST and keep the household decision moving, even when one person doesn't have all the details. And because the DST is where employees decide whether to enroll in the TCO, getting the spouse's plan into the comparison can directly affect both household savings and employer savings.
Why the spouse's plan matters
The spouse's plan can change the recommendation significantly. At one transportation company, employees who skipped uploading a spouse's plan were recommended the company's own PPO 100% of the time because there was no other plan for the tool to evaluate.
When employees did upload a spouse's plan, the spouse's plan combined with the TCO was the optimal choice in 50% to 76% of recommendations across our case studies, including 69% at an enterprise ecommerce company and 76% at a national distributor.
The spouse's plan is the one most likely to be missing. Employees often don't have copies of those plan documents. Their spouse does, usually in their inbox or their employer's benefits portal.
A redesigned starting point for the DST
During open enrollment, the DST is often where an employee starts to consider whether the TCO makes sense for their household. Previously, employees could navigate to the DST without much context about the benefit they were about to evaluate. Many users also wanted to enroll directly in the benefit but had to go through the DST to do so. We've redesigned this experience to give them that context upfront, so they can understand the TCO before they start comparing their medical plan options.
The updated page opens with the button to start the DST, followed by a short video explaining how the TCO works and a set of frequently asked questions (FAQs): what's covered, whether enrolling costs anything, how reimbursement works, and what happens if they lose access to their spouse's plan.
The FAQs help answer employees common questions before they start the comparison, without having to email HR first.
A faster estimate with a similar plan
We've added a new way for employees to compare their coverage options with their spouse's plan, even when they don't have the spouse's plan documents in front of them.
Employees can now choose a similar plan from three sample options: Basic, Standard, or Comprehensive. Each option includes a sample premium, deductible, and out-of-pocket maximum, so employees can get an estimate without tracking down a plan document first.
This gives employees a way to keep moving during open enrollment, even when the spouse's plan information isn't on hand. They can get an estimate now and replace the estimate with the spouse's plan later if they get the plan documents.
The goal is simple: employees don't have to stop their comparison just because the spouse's plan isn't easy to find.
Asking the spouse directly
Health insurance often treats spouses as if they're making separate decisions, even when they're choosing coverage for the same household. The DST now gives both people a way to participate, so the person who has the plan information can add it directly.
If an employee doesn't have their spouse's plan documents, they can click "Ask my spouse to do it" and enter their spouse's email address.
Healia sends the spouse an email explaining that the employee is comparing the household's coverage options, along with a link to provide their plan information. The spouse can log in using the email address the request was sent to, verify their identity, and upload a plan document such as a benefits booklet, Summary Plan Description (SPD), or Summary of Benefits and Coverage (SBC).
The upload page also explains what the TCO covers, including deductibles, coinsurance, and copays on the spouse's plan, so the spouse understands what they're providing and why it matters.
Once they upload the plan, the spouse can see the same household comparison as the employee, including each coverage option and its estimated annual cost. Both people can review the numbers together before deciding how to structure their coverage.
Spouses don't always upload their plan right away, so the employee can still get an estimate and review their coverage options while they wait. They choose a similar plan to stand in for the spouse's plan, and the DST marks the spouse's plan as pending. Once the spouse uploads it, the DST swaps in the spouse's plan and updates the comparison.
Both spouses, one comparison
When we first wrote about the DST, the goal was to show every household what each coverage option could cost. That depends on having both spouses' plans in the comparison. These updates give employees more ways to add the spouse's plan, even when they don't have it, and give the spouse a way to add it themselves. For a decision that affects both people, the technology should make room for both of them.
Frequently asked questions
What is Healia's Decision Support Tool (DST)?
The DST is where employees can compare their household's coverage options during enrollment, including their company's plans, their spouse's plan, and the TCO. It calculates the estimated annual cost of each option and gives the employee a personalized recommendation.
Why should HR teams encourage employees to complete the DST?
Employees decide whether to enroll in the TCO based on what the DST shows them, and the comparison only includes the TCO when the spouse's plan is in it. When employees upload a spouse's plan, the spouse's plan plus the TCO is the optimal choice in 50% to 76% of recommendations across our case studies. Employees who followed the DST's recommendation saved an average of $4,510 per family at an enterprise ecommerce company and $7,053 per family at a national distributor. Every family that moves to a spouse's plan with the TCO is also one fewer household on the company plan.
Can a spouse upload their own health plan?
Yes. The employee can enter their spouse's email address, and Healia sends the spouse a link to provide their plan information. The spouse logs in with that email, enters a verification code, and uploads a benefits booklet, SPD, SBC, or another plan document. The plan is then added to the employee's results.
Can the spouse see the household's coverage options?
Yes. After uploading their plan, the spouse sees the same household comparison as the employee, including each option's estimated annual cost. Both people can review the numbers before deciding how to structure their coverage.
What if an employee doesn't have their spouse's plan details?
They can enter a few details about the spouse's plan, such as the spouse's per-paycheck premium and the family's typical medical spending, or choose the closest match from three sample plans. Either option gives them an estimate in the same session, without the spouse's plan document. They can also invite their spouse to upload the plan and update the estimate once it's added.
Do HR teams or brokers need to do anything to get these updates?
No. These updates are live for every Healia client, and there is nothing HR teams or brokers need to change.
Talk to our team to see the new DST experience and spouse invite in action.