Every open enrollment, HR teams hear some version of the same question: "Which health plan is going to cost my family the least?" It's a reasonable question, especially when employees are looking at several medical plans with different premiums, deductibles, copays, and coverage options. For employees who have access to health insurance through a spouse, there are even more possibilities to consider.
Answering that question for every employee is difficult. HR teams know their company's benefits, but they generally don't know what an employee's spouse pays for coverage, how much healthcare their family expects to use, or whether splitting family members between two plans could save money. Those details can make a significant difference in which option costs the least.
Healia's Decision Support Tool (DST) helps employees compare their health plan options based on their household's needs. It considers their employer's medical plans, a spouse's plan when available, and potential reimbursements through Healia's spousal Health Reimbursement Arrangement (HRA). The DST then estimates the total annual cost of each option so employees can see which could help them save the most on healthcare.
We've created a five-minute video walkthrough that HR teams can share during open enrollment. It demonstrates how employees can use the DST, add a spouse's health plan, estimate their healthcare expenses, and review their personalized recommendations.
Watch: How to use Healia's Decision Support Tool
The DST is available to employees whose employers offer Healia, and their employer's medical plans are already loaded into the tool.
The walkthrough covers the full experience, including how to compare coverage for an individual or family, involve a spouse in the process, and understand the estimated costs behind each recommendation.
Comparing health plans starts with understanding the household
The DST begins by asking employees a few questions about who needs health coverage. Someone choosing insurance for themselves will have different considerations than a family with two working spouses and children. Even within the same company, employees can have very different healthcare needs, which is why the DST calculates recommendations for each household.
Employees can also estimate how much healthcare they expect to use during the coming year. The DST includes minimum and maximum healthcare usage scenarios, along with a custom option where employees can enter their anticipated doctor visits, prescriptions, and other medical expenses. These estimates help employees understand how their costs might change depending on how much care they need.
This is particularly useful when comparing plans with different premium and deductible structures. A plan with a lower monthly premium may have higher out-of-pocket expenses when someone needs care, while another plan may cost more in premiums but cover a greater share of those expenses. By estimating the total annual cost of each option, the DST gives employees a more complete picture of what they could spend throughout the year.
Why including a spouse's health plan matters
For employees whose spouses have access to health insurance through their own employers, adding that coverage to the DST can make a substantial difference in the results. Spousal coverage creates additional options for how a household can enroll, including the possibility of using Healia's Total Care Option (TCO), a spousal HRA that reimburses eligible healthcare expenses when a family enrolls in qualifying coverage through a spouse's employer.
We've seen how much this matters in our own client data. At one transportation company, the DST recommended the company's PPO for 100% of employees who completed their comparison without adding their spouse's plan. When employees included their spouse's coverage, the recommendations changed. Across our case studies, a spouse's plan paired with the TCO was the least expensive option in as many as 76% of recommendations.
Those recommendations can translate into meaningful savings for families. At an enterprise ecommerce company, families who followed the DST's recommendation are expected to save an average of $4,510. At a national distributor, families who enrolled in the TCO saved an average of $7,053.
Of course, getting employees to include their spouse's plan can be a challenge. Their spouse's benefits information may be in a separate employer portal, sitting in an email inbox, or simply unavailable when the employee first starts their comparison. The DST gives employees several ways to add that information, including uploading plan documents, entering plan details manually, or selecting a similar sample plan to receive an initial estimate.
Employees can also select "Ask my spouse to do it" and send their spouse an invitation to upload the plan directly. Their spouse can then participate in the comparison, making it easier for both people to review their household's coverage options together. Employees who want to get started immediately can use a sample plan while they wait for their spouse to provide the actual details.
We've written more about the importance of reaching spouses during open enrollment in Open enrollment has a plus-one, including ways HR teams can encourage employees to involve their spouses in the decision.
Understanding the personalized recommendations
After employees enter their household information and estimate their healthcare usage, the DST compares the available coverage combinations and ranks them by estimated total annual cost. Each recommendation accounts for the premiums paid by the employee or spouse, expected out-of-pocket expenses such as deductibles and copays, and potential reimbursements through Healia's TCO when applicable.
Employees can expand each option to see the estimated cost breakdown and understand how the numbers were calculated. They can also explore different coverage combinations, including enrolling the entire family in one plan or splitting coverage between two plans. The DST gives employees a way to compare those possibilities using the same assumptions about their household's expected healthcare needs.
For some families, staying on their employer's medical plan will be the least expensive choice. For others, enrolling in a spouse's plan and electing the TCO could result in lower overall costs. The recommendation depends on the plans available, the people being covered, and the healthcare expenses the household expects to incur.
Once employees have reviewed their results, they can use that information to make their enrollment decisions through their employer's benefits enrollment process. Employees who are eligible for the TCO should also follow their employer's instructions for electing that benefit. If questions come up during the comparison, Healia's support team is available to help employees understand their options.
How HR teams can share the walkthrough during open enrollment
HR teams already have plenty to communicate during open enrollment, and employees often receive a large amount of benefits information in a relatively short period. Giving employees a short video that demonstrates how to compare their health plan options can help them get started with the DST and understand what information they'll need before making their elections.
We recommend including the walkthrough in your open enrollment communications alongside your company's DST link. It can be shared in employee emails, added to a benefits portal, included in open enrollment education materials, or sent as a follow-up after a benefits fair or webinar. Employees can watch the video before starting their comparison or refer back to it if they have questions while using the tool.
It's also worth encouraging employees to share the video with their spouses, particularly when both people have access to employer-sponsored health insurance. Their spouse may have plan documents or information about premiums that the employee needs to complete an accurate comparison. The DST's spouse invitation feature gives households a way to work together even when they aren't reviewing their benefits at the same time.
For Healia clients, the employer's medical plans are already loaded into the DST, so employees can begin their comparisons using the link provided by their HR team. If a spouse's plan is available, including it will give the DST more information to work with and help employees evaluate the full range of coverage options available to their household.
Help employees make informed health plan decisions
Choosing health insurance involves several costs that can be difficult to compare, particularly when a household has access to coverage through two employers. The DST brings those options together and helps employees understand what each one could cost based on their expected healthcare needs.
If your company already works with Healia, share the walkthrough with employees during open enrollment and encourage them to include their spouse's plan when applicable. Employees can use their company's DST link to begin comparing their options.
If you're interested in learning how Healia can help your employees compare health plans and potentially reduce your organization's healthcare costs, talk to our team.