Why Employees Push Back on Good Health Plans: 10 Communication Mistakes Brokers Can Help Employers Avoid
Learn 10 practical ways brokers can help employers explain health plans more clearly, reduce confusion, and build employee confidence
Table of Contents
- Good benefits need clear communication
- Explain what changed before employees compare costs
- Show employees how the plan works in everyday situations
- Replace insurance language with plain english
- Explain why the employer made the change
- Give employees more than one opportunity to learn
- Prepare managers and hr teams to answer common questions
- Make pharmacy benefits easier to understand
- Use visuals instead of long documents
- Remind employees where to get help after enrollment
- Review employee questions to improve next year’s communication
- Better communication helps good plans deliver better results
- Key takeaways
Good benefits need clear communication
An employer can spend months reviewing costs, networks, plan designs, pharmacy benefits, and employee contributions, then make a thoughtful final decision.
Employees can still walk away unhappy.
They may focus on a higher deductible without understanding other changes to the plan. They may think their doctor is covered when the provider is actually out of network. They may not know why a prescription costs more, when enrollment closes, or where to go when they have a question.
For brokers, that creates a familiar problem. The plan decision may be sound, but employees are judging it based on the information they received and what happens when they try to use their benefits.
The confusion is not unusual. KFF found that about half of insured adults have difficulty understanding at least some aspects of their health insurance.¹
That makes communication part of the plan strategy. As final decisions are made, brokers can help employers think beyond what employees need to enroll and consider what they need to understand the plan after enrollment is over.
Here are 10 communication mistakes worth addressing with your clients.
Explain what changed before employees compare costs
When employees receive new benefits information, many go directly to the numbers.
What will come out of my paycheck? Did my deductible increase? How much will I pay when I see a doctor?
Those questions are reasonable, but looking at one number without context can give employees an incomplete picture of the plan.
Help the employer clearly identify what is changing and what is staying the same. That could include:
- Employee contributions
- Deductibles and out-of-pocket maximums
- Copays and coinsurance
- Provider networks
- Prescription coverage
- Covered services
- New programs or resources
- Enrollment requirements
The goal is to make the differences easy to find. Employees should not have to compare two long benefits guides to figure out what changed.
If a change will affect how employees access or pay for care, put it where they will see it.
Show employees how the plan works in everyday situations
A benefits presentation can explain a deductible correctly and still leave employees wondering what they will actually pay when they need care.
Examples make plan details easier to apply.
Instead of stopping at a chart of deductibles, copays, and coinsurance, show what those terms could mean in situations employees recognize.
For example:
- What happens when you visit your primary care doctor?
- What happens when you see a specialist?
- What should you check before filling a prescription?
- What could happen if you go to the emergency room?
- How does using an in-network provider affect your costs?
The examples should reflect the actual plan. Avoid giving employees an oversimplified cost estimate that may not match their claim.
You are helping them connect the plan document to the decisions they will make throughout the year.
Replace insurance language with plain English
Health insurance terminology is difficult to avoid completely. Employees still need to know what a deductible, coinsurance, out-of-pocket maximum, or prior authorization is.
The mistake is using those terms without explaining what they mean.
A deductible, for example, can be described as the amount an employee may need to pay for certain covered healthcare services before the plan begins paying its share, depending on the plan.
Coinsurance can be explained as the percentage of the allowed cost the employee pays for certain services after applicable plan requirements are met.
Prior authorization can be described as a requirement for the health plan to review and approve certain services or medications before they are covered.
Plain English does not mean removing the correct terminology. It means giving employees enough context to understand what the terminology means for them.
Brokers can help employers review benefits materials with a simple question: Would an employee who does not work in healthcare understand what to do after reading this?
Explain why the employer made the change
When an employer changes carriers, modifies the plan design, adjusts contributions, or introduces a new program, employees will naturally want to understand the reason behind the decision.
Give them a clear explanation.
Depending on the employer, that explanation might include managing plan costs, maintaining access to coverage, keeping benefits financially sustainable, expanding provider access, or adding resources employees can use.
Keep the explanation specific to the decision.
For example, if the employer changed the plan design to manage a significant renewal increase while maintaining the same provider network, explain that connection. If a new program was added to give employees another way to access certain services, explain how it works and who can use it.
A short explanation of the reasoning behind the change can give employees helpful context as they review their benefits.
Give employees more than one opportunity to learn
Sending a benefits guide and waiting for employees to ask questions puts too much responsibility on a single communication.
Benefits information is easier to absorb when it arrives at the point employees need it.
Before enrollment, focus on what is changing, what employees should review, and what decisions they will need to make.
During enrollment, provide plan comparisons, deadlines, decision resources, and answers to common questions.
After enrollment, shift the focus to using the benefits. Remind employees where to find ID cards, how to locate participating providers, where to get prescription information, and who to contact for help.
Health benefits represent a significant part of the benefits package employers provide. Giving employees several opportunities to understand that coverage helps make the information easier to use when they actually need care.
Prepare managers and HR teams to answer common questions
HR is not always the first person an employee asks about benefits.
An employee may ask a manager why payroll deductions changed, whether the company switched health plans, or what happened to a particular benefit.
Managers should not be expected to interpret coverage or answer detailed claims questions. They can, however, be prepared to give employees accurate basic information and direct them to the right resource.
Before communications go out, brokers can help HR prepare a short set of talking points covering:
- What is changing
- Why the change was made
- Important enrollment dates
- Where employees can compare their options
- Who can answer plan-specific questions
- Where employees should go for help with claims, providers, or prescriptions
This also gives HR a consistent message to share across the organization.
Make pharmacy benefits easier to understand
Prescription coverage can become a source of confusion when employees know they “have pharmacy benefits” but do not know the rules that affect a specific medication.
Pharmacy communication should tell employees what they need to check before they reach the pharmacy counter.
Depending on the plan, that may include:
- Which pharmacies participate in the network
- Whether the plan has preferred pharmacies
- How employees can check whether a medication is covered
- Whether certain drugs require prior authorization
- How specialty medications are handled
- Whether home delivery is available
- Where employees can get help with an expensive or rejected prescription
If pharmacy benefits are changing, employees taking ongoing medications may need additional notice. Give them enough time to check whether their medication, pharmacy, or refill process will be affected.
A short pharmacy-specific guide can often be more useful than burying those instructions inside the full benefits booklet.
Use visuals instead of long documents
Benefits documents have a purpose. They are rarely the easiest way to explain every plan decision.
When employees need to compare options or understand a process quickly, a visual format may work better.
Consider using:
- Side-by-side plan comparison charts
- Frequently asked questions
- One-page plan summaries
- Decision guides
- Short educational videos
- Simple step-by-step instructions
Match the format to the question.
A comparison chart can help someone choose between plans. An FAQ can address common enrollment questions. A one-page guide can show employees what to do when they need a prescription or cannot find their ID card.
Employees can still have access to the detailed plan materials. The shorter resources help them find the information they need without searching through every page.
Remind employees where to get help after enrollment
Enrollment ends. Benefits questions do not.
Some questions only appear when an employee tries to use the plan. A claim is denied. A provider cannot be found in the network directory. A prescription costs more than expected. An employee receives an Explanation of Benefits and does not understand it.
Employees should know where to take each type of question.
Depending on the plan, resources may include:
- Customer service
- Member support or advocacy resources
- HR or the benefits team
- The health plan’s member portal
- Pharmacy support
- Provider search tools
Be clear about which resource handles which problem.
“Contact us if you need help” is less useful than telling employees exactly who to contact for a claim question, prescription issue, provider search, or enrollment correction.
Review employee questions to improve next year’s communication
Employee questions can tell brokers and employers where the communication missed something.
If HR repeatedly hears, “Is my doctor still in network?” that is useful information. The next communication can make provider verification easier to find.
If employees repeatedly misunderstand how the deductible works, the next enrollment presentation may need a practical example.
If prescription questions increase after a pharmacy change, employees may need clearer instructions before the new benefit takes effect.
Encourage clients to keep track of:
- Frequently asked questions
- Topics that require repeated explanations
- Benefits employees commonly misunderstand
- Questions that appear after enrollment
- Resources employees have difficulty finding
This does not require a formal research project. Even a simple list from HR can help you identify where the next round of communication should be clearer.
Better Communication Helps Good Plans Deliver Better Results
Employees experience a health plan through more than its deductible, network, and premium. They experience it when they choose coverage, schedule care, fill prescriptions, receive claims, and look for help.
That gives brokers several opportunities to support the employer after the plan decision is made.
Review the communication alongside the plan. Look for the questions employees are likely to ask, identify the changes they are most likely to notice, and make sure they know what to do when they need care.
That work can also make future conversations with the employer more productive because you have a clearer picture of where employees need additional support.
Looking for more ways to help employers communicate health benefits with confidence? Explore Trinity’s resources for brokers covering plan strategy, employee communication, and smarter renewal conversations.
Key Takeaways
- Explain plan changes early and clearly.
- Use real examples to explain coverage.
- Replace insurance jargon with plain English.
- Communicate before, during, and after enrollment.
- Prepare HR and managers for common questions.
- Give pharmacy benefits their own communication.
- Use employee questions to improve future materials.
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