When employees go to the doctor or dentist, they almost never have to file their own claims, since medical offices typically have a team of people who work with insurance companies directly. While this keeps things simple for the employee, when supplemental health insurance claims are added to the equation, things can get far more complicated.
“Supplemental health coverage is a benefit that is paid directly to the covered employee and the industry has relied on the individual to submit the claim for this reimbursement,” says Tim Weber, vice president of voluntary benefits distribution at Prudential Group Insurance. “Because individuals have never been exposed to this level of detail they find it very difficult to both understand the process and chase the information needed to submit the claims.”
In early 2020, Prudential Group Insurance hoped to simplify this process by introducing its medical claim monitoring program, which monitors medical claims that could be eligible for supplemental health requests.
Supplemental insurance is additional insurance employees can purchase on their own or utilize through a benefit if their employer offers it. Supplemental insurance makes it easier for employees to pay expensive out-of-pocket medical costs that regular insurance wouldn’t cover, including copayments, coinsurance and deductibles.
But the difficulty of the claims process often prevents employees from taking advantage of the value it offers, Weber says.
“Almost always, [employees] say they just don’t find value in it because it’s so hard to make a claim,” he says. “We said let’s rise to that challenge— if people are telling us it’s hard to file a claim, let’s make it easier.”
In a recent one-on-one interview, Weber discussed the program and the advantages it can bring.
What is Prudential's medical claim monitoring program and how does it work?
As part of the opt-in, employees provide authorization for Prudential to monitor their medical claims to identify medical services that are eligible for a supplemental health benefit.
When we identify an eligible medical service, we check to see if the employee has already submitted a supplemental health claim. If they haven’t, we reach out to the employee to help them submit the claim, show them how to check claim status, and see if there is anything else we can do to help them through this difficult time.
What value does this program bring to employers and employees?
The value for the employee is removing the hassle and worry of getting the financial benefit from their coverage and safeguarding their financial wellness as they deal with an unexpected medical event. Individuals already have high expectations for what a digital experience looks like thanks to innovations in other industries. The pandemic has only made this more prevalent as we have fewer in-person interactions and increased digital connectivity.
An employee’s view of their benefits is more than just the price and level of coverage. The claims process is a crucial component of the overall value a benefits package provides. Improving the claims experience for their employees helps employers cultivate loyalty among those who truly feel they understand and receive the value offered through their benefits – especially as 52% of employees say they’d be willing to take a chance on a new job if better benefits are offered.
What mistakes do employers and employees make when it comes to utilizing supplemental medical insurance?
Employers often select supplemental health coverage primarily based on the premium and level of benefits provided. But LIMRA data shows that employees don’t have a great perception of claims experience – so you end up with a sizable population that is balancing the consequences of an unexpected medical expense with the frustration of using their benefits. After hearing multiple complaints about the experience and seeing low benefits utilization, employers may question whether they even need to offer these benefits in the first place, which in itself is a major disadvantage for employees who want and need that extra layer of financial protection.
The solution is simple – making sure employees have coverage with a simple claims experience makes it easier for employees to get value from their benefits. This not only includes simplifying the experience, but also educating employees on how to successfully file a claim before they actually need to. Utilization will rise and the value of the coverage will be recognized.
