Many Group Health Plan Users Make Costly Mistakes

Employees who are unfamiliar with how to access care using their group health insurance can inflate your plan costs and how much they pay out of pocket.

Those who may not use their health plan much, or at all, may end up going to the emergency room for an issue that could have been handled by a general care physician in their plan network. While they may not think much about the added cost when they seek non-emergency care in the emergency room, they do when they get a bill in the mail later.

The average cost of an ER visit with insurance in 2024 was around $400-$650, with the typical copay after meeting the deductible being around $412 nationwide, based on US Department of Health information. But some visits can go into the thousands of dollars for serious cases.

With health plans absorbing a portion of ER costs, decisions like this can negatively affect your plan as well.

The key to helping your staff avoid this is educating them on the health insurance they have, how to use it and also the importance of keeping up on vaccinations and checkups, particularly if they have children covered under the plan.

Everyday conditions

With common conditions like headaches, sore throats or flu-like symptoms, employees often have access to more affordable care options than the emergency room. Virtual visits, for example, typically cost between $40 and $80, while retail clinics range from $20 to $100.

These options provide fast and convenient care, often with shorter wait times. Urgent care clinics are another excellent alternative, offering treatment for non-life-threatening conditions at a fraction of the cost of an ER visit.

Also, appointments with their primary physician in person for other issues are significantly less costly than the emergency room, particularly for plans with low copays.

One way your employees can find the best care for their needs is to check out FindTheRightCare.org, a resource created by the non-profit Health Action Council that’s designed to help employees explore health care options that fit their symptoms and budget.

Shopping around for scheduled procedures

For planned medical procedures like knee replacements or imaging tests, you can encourage your employees to shop around within their insurance network. Costs for these services can vary widely depending on the provider, and selecting a facility with lower cost-sharing can lead to substantial savings.

One way to simplify this process is by directing employees to cost-comparison tools offered by their health insurer or external resources, like the Health Action Council’s website. Transparent pricing information allows employees to make well-informed choices while staying within their budget.

Preventive care and vaccinations

Encourage your staff to schedule regular checkups with their primary care physicians, who provide comprehensive care, monitor ongoing health concerns and offer guidance on vaccinations.

For families with children, well-child visits are essential for tracking growth, monitoring developmental milestones and staying current on vaccinations. These visits protect children from serious diseases like measles and whooping cough, which are highly contagious and can have severe consequences, particularly for young children.

Education is key

Provide training and resources from your health plans that explain how employees can use their health benefits effectively.

A 2024 poll by Employee Benefit News found that 89% of employers surveyed were taking steps to control health care costs, with a majority focusing on improving preventive care access. They were incentivizing preventive care in a few ways:

• 39% hosted vaccination sessions at the office,
• 32% hosted educational talks or webinars about preventive care, and
• 31% hosted disease screenings.

By equipping employees with knowledge, tools and resources, you can help them save money on their health care outlays without compromising their care or health.

That helps your bottom line as well, particularly if your health plan is not paying for expensive care when it could be delivered at a lower cost.