The U.S. health care system is complex, and patients with even the most robust benefits can become frustrated and confused about what they need and the services that are available to them, keeping them from utilizing the right care at the right time.
“Almost two-thirds of consumers say they are overwhelmed by trying to determine the care they need, and 60% say they need help determining what their plan covers,” said Mark Bini, senior vice president, Evernorth Care Solutions. “A recent study from the Evernorth Research Institute showed us that that a large majority of employers overestimate their members’ ability to manage the complexities of their coverage and care – in other words, the benefit offerings their employers have invested in.”
Helping members understand benefits management
When employees misunderstand the benefits their employers prioritize and implement, they are less likely to utilize those benefits. For example, Evernorth has found that as many as half of all employees are concerned about a reduction in overall wellness benefits, yet employers rank health and wellness benefits as a top focus of their benefits strategy.
Benefits management solutions that incorporate personalized learning and customized communications can help bridge those gaps and increase member awareness, engagement, and health insurance literacy.
“By providing a roadmap to care, personalized communications paired with simple, intuitive, and meaningful digital experiences can help people access the services they need,” said Amber Burrus, product strategy senior director, Evernorth. “At the same time, these solutions can help employers curb medical trend, reduce administrative hassles, and provide transparency into vendor performances and the plan’s overall return on investment.”
What members and plan sponsors gain by understanding benefits
Health insurance literacy is linked to stronger vitality and may have an impact on health care experiences and utilization. According to vitality research from The Cigna Group:
- 75% of adults who have high health insurance literacy – defined as confidence in understanding health insurance benefits and how to use them – are satisfied with their job benefits (2024 Vitality Index).
- 94% of people with high health insurance literacy are satisfied with their health insurer (2024 Vitality Index).
- Conversely, adults with low health insurance literacy are much more likely to have received an unexpected bill, faced an unexpected out-of-pocket expense, or received an adverse coverage decision (32% vs. 14% of adults with high health insurance literacy) (Q2 2024 Vitality Pulse).
“We’ve found that people who have a clear understanding of their health conditions and the health care system are more likely to use health care services appropriately, which includes getting preventive care and following treatment plans,” Bini said. “As a result, they are far less likely to make unnecessary – and costly – visits to the emergency department too.”
