Using the "Ass-U-Me" Method for Benefits

Here’s the usual scenario, employees in an organization want a benefit plan. The employer calls someone who does a market study of available plans with the goal of the least costing program being the winner. The plan is placed and here we have the first assumption—that coverage will be there when we need it.

Remember the famed John Glenn quote from when he was asked how he felt prior to his 1962 Atlas Rocket launch from NASA:

“I felt exactly how you would feel if you were getting ready to launch and knew you were sitting on top of two-million parts—all built by the lowest bidder…”

Lowest cost does not equal BEST coverage

Sometimes benefits are like that. We go with the lowest cost without asking questions on what exactly are we paying for or choosing to work with someone not equipped or experienced enough to ask the questions in the company’s best interest. Then, at the end of the day, we don’t know what benefits claims are covered because no one has asked.

We “assume” we know what we are paying for until the first claim goes in and is declined.

Administration

Everyone’s busy. That’s a fact.

For those companies who don’t employee full-time or even fractional human resource people, the administration of the benefit plan often lands at the door of those in charge of payroll or other office administration because it is “assumed” all there is to this benefit plan is paying the monthly bills, enrolling and terminating staff.

There is where a lot of the errors on benefit plans are made.

• Employees are not enrolled in a timely manner, then are declined or limited in their coverage.
• Employee families not being properly enrolled.
• Employees are not terminated properly and the company pays for people who are not “actively at work”.
• Severance for terminated employees is offered without carrier approval and uninsurable benefits promised which wouldn’t be paid in the event of a claim because the employee is not “actively at work”.
• Including staff that wouldn’t be eligible for coverage on benefits.
• Salaries not kept up to date and where there is a life or disability claim the employee’s claim is hampered, reduced or not eligible at all.
• Employees not provided with accurate information on obtaining additional coverage and forms not submitted.
• Allowing employees to randomly “waive” coverage contrary to the policy contract.

…and then it’s too late

This is where employee’s get caught in the “assumption” circle.

Because there has been no on-going education on the coverage and what to expect, things to be aware of, and how to utilize the program most effectively, employees often get caught in calling to seek coverage when there is a crisis and the employer and insurer have to decline.

Here’s a snippet of that conversation:

“The employee has been hospitalized and needs to go on disability claim. Can we get that started?”

All too frequent situations:

1. There is no disability coverage in place on the company plan.
2. The employee has not been effectively or perhaps accurately enrolled onto the plan.
3. The employee’s salary has not been kept up to date.
4. The employee was never provided with the option to increase coverage and may be limited to the non-evidence maximum.

This costs employees both financially and emotionally/mentally. Lack of protection when you need it most can drastically impact the rest of a person’s life, all because the benefit plan was placed based on an “assumption” model, rather than a strategic analysis.

Let’s have a conversation.

Reach out if you would like to explore your corporate benefit options, like:

• Analyzing current coverage to ensure best match to needs.
• Flexible models best suited to various classifications of employees
• Using health spending accounts as the non-taxable bonus to align with the Group RRSP

Note: this was written without the aid of Artificial Intelligence (AI)

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