Communicate Health Benefits Information More Effectively

All employers have responsibility of guiding their employees about the health benefit schemes offered by them. Even the employees on the other hand also have the right to receive information about the health benefit schemes offered to them. Therefore an employer has the right to inform the employees about certain information regarding the health benefit schemes. For this reason, organizations have created the position of Health Benefit Manager having communication as one of the responsibilities for health benefit related schemes and procedures.

Key information heads to be shared by employer

There is a plethora of information available for communication. It is the skill of the Health benefit Manager to present them in a structured manner on behalf of the employer.

- Employers need to provide a detailed list of information to the employees about what health benefit schemes are provided to them or the scheme they are entitled to.
- Providing information regarding cost sharing as well as arrangements
- To take up necessary steps to resolve problem as well as to deal with appeals.
- To provide and guide its employees about the status of accreditation, certification as well as licensure.
- Provide sufficient and necessary information about the composition of the provider network too.
- To use the emergency care services as when required by the employees of the organization.
- To obtain referrals to specialists
- Most importantly provide all the information regarding the quality, safety of the health benefit plan and the cost of the employer sponsored plan.

Regulatory directives
According to the Employer Retirement and Income Security Act of 1974, it is necessary to provide all detailed information that the employees are entitled to that includes plan rules, covered benefits, documents about the plan management and operation as well. The employees are also entitled to receive a document with the summary plan description, known as SPD. The SPD contains

- Information of the health care services that are covered in the plan.
- Description of what services are being provided by the plan and how these schemes function.
- It provides information also on how to calculate the benefits.
- Explanation on the cost that the plan covers and the cost that the beneficiary has to pay.

Tools and Methods for communicating
There are various methods by which the Health Benefit Manager, on behalf of the employers, can communicate health benefit information to the employees:

- One of the best ways is to communicate with the employees about the health coverage plan but providing too much information of it should also be avoided. The employees should be given the required time to understand the scheme and ask questions if any.

- It is best to explain the changes in simple terms to the employees to make them understand.

- Apart from the employees it is also necessary to explain the health benefit plans to the health benefit managers so that they can explain it to the employees to.

- Employers should be ready to face any questions asked by employees regarding the health benefit scheme and clear their doubts.

- It is equally important as well to be direct and honest when discussing about the coverage plan especially if employees face cost increase due to the coverage plan.

- Discussing the 5C’s too is essential with the employees. This 5C’s include cost, changes in plans, coverage of the plan, comparison of the previous year’s plan and also the current option.

- It is necessary to provide information the employees about the health care providers that are available in the revised and new plan option.

- Providing testimonials of other employees about the changes in health benefit plans can also be quite helpful for the present employees.

- Taking the help of various means like internet, face to face discussions, telephonic conversations, office intranet as well as printed materials can be helpful too. However it is also necessary to use materials that are easily understood by employees.

Using health communication campaigns

What are its advantages?

- It is important for the employers to conduct communication campaigns to educate the employees about the need of health benefit schemes and how they operate.

- The responsible manager’s aim should be to identify the objective and aim of the health care campaign.

- To develop health care message that meets the objectives and aim of the campaign.

- Setting up the criteria for evaluation of the campaign and also the degree to which it is getting conveyed among the employees.

- To implement and the campaign and make sure that the employees understand message that is being conveyed by the employer.

- It is also necessary to make sure that the employees also to address the education need of the employees with language barrier, literacy issues etc.

To conclude, an effective way to communicate about the health benefit scheme is the cornerstone of every business organization. In these schemes, employers can also guide and help its employees to select a scheme and explain every detail they should know. The authority should also explain the new health scheme option and also about the changes in the existing benefits. To improve the health plan costs the employer’s must keep in mind the factor of low health literacy. Health plans and employers should also be able to successfully communicate with employees. Lastly, employees and employers should also be able to communicate clearly about the health benefit plans.

Telemedicine in the Affordable Health Care Act Explained

Telemedicine is an important component of the robust and technology driven Affordable Care Act system (Obama care) and provides avenues for reducing costs in the new healthcare structure, because it offers options in how to access healthcare services.

The Affordable Care Act is the most comprehensive overhaul of the nation’s health care system in decades and it’s implementation and sign-ups will all be processed through marketplace exchanges.

What is the Meaning of Telemedicine?

Telemedicine is the use of telecommunication and information technology to provide clinical health care without a traditional face-to face consultation. It helps eliminate distance barriers and can improve access to supplementary medical services for people with:

Basic or No Insurance
High Deductible (HDHP) Insurance
Traditional Insurance

Tele-health Vs Telemedicine

‘Tele-health’ is an older, broader term for services such as health education and is not limited to clinical services, while ‘Telemedicine’ narrowly focuses on the actual curative aspect between the patient and healthcare professional. Examples of Tele-health are health professionals discussing a case over the telephone or conducting robotic surgery between facilities at different ends of the world.

Tele-Health has a broader scope than telemedicine and is sometimes called e-health, e-medicine, or telemedicine. Health care professional use tools like e-mails, e-visits, e-prescribing, after-hours care, e-reminders, health assessments, self-management tools, health coaching etc.

The State of the Market

The Affordable Care Act (Obama Care) Health Insurance Exchange (HIX) opens on Oct 1st, 2013. and goes into operation on Jan 1st, 2014. The Obama Care exchanges, are State, Federal or joint-run online marketplaces for health insurance. Americans can use their State’s “Affordable” Insurance Exchange marketplace to get coverage from competing private health care providers.

Steps to Sign up for Health Care Plans

Participants enter personal information into a web portal
Learn their eligibility for subsidies based on income, state-determined criteria or employer-based options.
Use a price calculator to shop, compare and choose a best benefit health plan.

Several major health companies have programs like TelaDoc in Aetna, KP-OnCall in Kaiser etc, trying to set up footholds in a market that is widely expected to grow rapidly. All participants have to do is research for telemedicine benefits through their health insurance plans or sign up for independent programs.

How Health Care Professionals Administer Telemedicine

Doctors can treat most everyday health needs by phone or a scheduled video consultation. A study by the American Medical Association shows that 4 out of 5 visits to a primary care doctor could have been treated over the phone instead. After each consultation, patients will receive a clinical report which can be emailed to a primary care physician.

Registered Nurses manage triage calls and act as health coaches. For some specific symptoms, they give guidance for the most appropriate care, and over 32% of the time will offer self-care options so patients avoid a visit to the doctor, ER or Urgent Care facility entirely.

Common symptoms often treated through Telemedicine

Respiratory Infections, Cold/Flu Symptoms, Urinary Tract Infections, Sore Throats, Headaches/Migraines, Sinusitis, Allergies, Insect bites, Certain Rashes, Sprains/Strains, Arthritic Pain, Stomach Aches/Diarrhea, Gastroenteritis, Minor Burns and many non-emergency medical conditions

By 2014, the law mandates that all non-exempt Americans have health insurance or face a tax penalty. The Affordable Care Act has far-reaching advantages such as prohibiting insurance companies from dropping a clients’ coverage if they get sick or discrimination against anyone with a pre-existing condition and extending children’s eligibility on parent’s plans.

For entrepreneurs, who will most likely be responsible for their own health insurance, knowing how telemedicine can supplement their health insurance plans, means they can take full advantage of the options, savings and benefits.

Ama Danesi is an author, entrepreneur, marketer and business consultant, with an MBA in Financial Manag