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Do Your Employees Know How to Use Their Health Benefits?

It's important to understand how your health plan works before you start using services. Doing so can save money – for both you and your employees.

Many people are uncertain about how to use their health benefits. According to a recent survey from Bend Financial:

  • 56% of Americans admit to feeling "completely lost when it comes to understanding health insurance."
  • The survey included a quiz with true/false and multiple-choice questions. Respondents answered 10 of 15 questions incorrectly.
  • The youngest respondents (those age 18-39) were most likely to believe they had done well on the quiz but performed the worst.
  • 59% of respondents have delayed health care appointments because of their uncertainty about coverage.
  • 53% have delayed filling a prescription because of uncertainty about coverage.
  • 35% delayed a check-up out of uncertainty about the cost.
  • 15% were not sure if they had health coverage.
Health coverage questions infographic


Confusion about health benefits can lead to delayed or inappropriate care that can increase costs for both employers and their plan members. But health insurance doesn't have to be difficult to use.

Employers should encourage their employees to read through the plan information before seeking services. Members should understand:

Where to go for care

Choosing the most appropriate health care provider can help members get the best and most cost-effective care.

  • Does your health plan use a provider network? If so, choosing a doctor and facility that is in network will save money. Allstate Benefits plans offer tools that help members find the highest quality providers with the best prices.
  • Emergency rooms (ERs) are typically the most expensive places to get care. You should only use an ER in cases of severe or life-threatening conditions.
  • Telemedicine services, such as Walmart Health Virtual Care1, offer convenience and the most cost savings. If your health plan includes telemedicine services, this is a good option to treat cold and flu symptoms, ear infections, headaches, cuts with controlled bleeding, and behavioral health issues such as depression, anxiety, and stress.
  • Your primary care provider's office is also a good choice for treatment, and often costs less than retail health clinics or urgent care centers.

Where to go for support

Employers can eliminate frustration and boost employee satisfaction with their health plan by ensuring members have the best customer service support.

The Self-Funded Program offered through Allstate Benefits includes experienced customer support that helps your employees understand their benefits, use their plans, find health care providers, and understand their Explanation of Benefits (EOB) documents.

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Common health insurance terms

  • Coinsurance – The portion of medical expenses that the covered person is responsible for paying after the deductible is met. Often, this is a percentage. For example, if a policy includes 20% coinsurance, the covered person is responsible for paying 20% of the medical expenses and the health care plan will pay the remaining amount.
  • Copayment – A copayment is the portion of medical expenses that the covered person is responsible for paying. Often, this is a specified dollar amount. For example, if a policy includes a $20 copay, that is what the covered person will pay the provider at the time of service and the health care plan will pay the remaining amount.
  • Deductible – This is an amount paid out of pocket by the covered person before a health plan pays any expenses. For example, if a health plan has a $1,000 annual deductible, the covered person must pay all medical expenses up to the first $1,000 each year before their plan benefits kick in.
  • Network – This is a group of doctors, hospitals, clinics and other health care providers and facilities that have a contract with a health insurance carrier to provide care at a discounted rate. These providers meet specific quality standards required by the health plan.
  • Network Only Plan – This is a type of medical plan that will only pay benefits if members see a healthcare provider within a specific network. Out-of-network services will only be covered for emergency services. The benefit of this type of plan is lower health care costs.
  • PPO – A PPO, or Preferred Provider Organization, is a type of medical plan that allows members to see any health care provider they choose. However, the PPO plan will pay a larger portion of the bill if the member sees a provider in their network. The benefit of this type of plan is a wider choice of providers.
  • Premium – This is the amount of money that is paid to the health plan for the policy. With group health plans, employers typically pay for some of the premium costs and the remainder of the premium is taken out of the employee's paycheck each month.
  • Retail clinic – An outpatient clinic located within a retail, grocery, or drug store. These clinics typically treat minor illnesses and injuries and provide preventive care, such as vaccinations.
  • Telemedicine – A visit with a health care provider that is conducted through telecommunications technology, such as a computer or mobile phone app.
  • Urgent care center – A walk-in clinic that primarily treats injuries or illnesses that require immediate care but are not serious enough for an emergency room visit. They are often open extended hours when primary care clinics are closed.

How can you help reduce confusion?

Consider using your employee newsletter and other tactics in your employee communications program to:

  • Encourage your plan members to review their plan materials before seeking services.
  • Educate your plan members about where to go for care and the meaning of common health plan terms.
  • Make sure your employees know where to find support when they have questions.

Contact a sales representative to learn more about how our customer service teams can help reduce confusion and increase savings and satisfaction with your benefits plan.

1Walmart Health Virtual Care offers medical consultations, behavioral health counseling, and talk therapy services via telehealth to patients nationwide. Services are provided in accordance with state law by physicians, nurse practitioners, and other licensed professionals. When medically necessary, Walmart Health Virtual Care providers may prescribe medication that patients can pick up at a local pharmacy. Virtual Urgent Care visits are not a replacement for a primary care physician or annual physical exam.

The Self-Funded Program through Allstate Benefits provides tools for employers owning small to mid-sized businesses to establish a self-funded health benefit plan for their employees. The benefit plan is established by the employer and is not an insurance product. Allstate Benefits is a marketing name for: Integon National Insurance Company in CT, NY and VT; Integon Indemnity Corporation in FL; and National Health Insurance Company in CO, WA and all other states where offered. For employers in the Allstate Benefits Self-Funded Program, stop loss insurance is underwritten by these insurance companies in the noted states.

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