I was walking on a major street in Vancouver a couple of days ago and I saw a sign outside a wellness spa that read “Take advantage of your extended health plan”. It did not read: “Use your benefits plan wisely”, or “Book a massage therapy appointment at the recommendation of your doctor”; it said “take advantage.”
While it’s nice to see more people appreciating the extra perks of their corporate benefits plans, these plans are meant to help employees pay for health and dental expenses that are medically necessary. However, the term “Take advantage” often translates to “I am entitled to services that are not completely medically necessary”. The unfortunate reality is that we as a society are now consuming health resources with the same voracious appetite that we are consuming everything else, and this consumerism attitude will affect the cost of employee benefit plans.
Massage therapists should not be singled out. Some optometrists, wellness spas and dentists are also advertising and encouraging more people to “take advantage” of a benefits plan. For instance, a number of dentists advertise on local radio stations to encourage patients to maximize the value of their benefits and a CBC Marketplace episode shockingly uncovered how some dentists view your mouth as a gold mine.
We cannot only blame clever wording, consumerism or unethical practices. Technologies such as e-claims, mobile apps, provider e-claims, and direct billing are making it easier for employees to spend their health care dollars faster. Yet amidst all this spending, they may not fully understand the true costs of employee health care and how it impacts the employer’s costs. Frivolous, want-centered and take-advantage spending hurts employees and their employers who are trying to keep their benefits costs sustainable and affordable.
5 Tools That Help Employers Promote Wise Healthcare Spending:
1. Establish a Dental Cleaning Routine. One unit of dental cleaning, otherwise known as scaling is 15 minutes. Many plans offer between 10-12 units of scaling per year. This is between 150-180 minutes (2.5-3 hours) of scaling each year. Once a proper dental routine is established, cleaning can be reduced to 6-8 units or 90-120 minutes per year.
2. Minimize Dental Recall Exams: Most plans offer a dental recall frequency of twice per year. In combination with 10-12 units of scaling this adds up to significant costs. Offering a recall frequency of one every 9 months can achieve comparable goals and lower costs.
3. Re-Institute “Medical Necessity” for Massage Therapy and Chiopractic Care. There has been a trend over the past couple of years to offer massage therapy benefits without a doctor’s referral, which in turn led to higher spending. Offering the same benefit with a doctor’s referral requirement may help curb some unwarranted spending.
4. Reasonable and Customary Charges: Work with an insurer that acts as a claims adjudicator and not just a claims payer. These insurers can help keep employee in line so they are not freely ‘taking advantage’ of plans.
5. Introduce flexible benefit plan: With a flex plan, employees can pick and choose the benefits they need and also pay for the benefits that are above and beyond what might be included in the cost of the plan. A flexible benefits plan keeps employees happy while ensuring the entire corporate plan remain affordable and sustainable over the long term.
If you are looking for ways to educate your employees on how to get the most out of a benefits plan without falling into the consumerist trap, a trusted benefits consultant can help. An experienced benefits consultant can help you make sense of complex claim information and help design a benefits plan that promotes employee health, provides the benefits that are important to the employees and keeps you on budget, year after year. Contact us today and see how we can help.
Whether you are with a business, association, or owner operator, we have the solution for your needs.