Top 10 Employee Questions on Private Exchange Enrollment

Top 10 Employee Questions on Private Exchange Enrollment
Towers Watson compiled these top 10 questions that full-time employees ask when enrolling in the company private exchange:

  1. Which plan has the lowest cost? Using premium cost as the most important criterion for making health plan choices could be a mistake because the least expensive plan is not always the best one. Employees should also consider their health status, the doctors and hospitals they use, and the prescription medications they take.
  2. What are the copays for the medical plans being offered? Historically, employees have gravitated toward the predictability of PPOs with copays, but these plans may cost more out-of-pocket and may not be the best choice for them. Some employees may be surprised to learn their employer doesn’t offer any copay plans. In these situations, it’s important to explain that there may be plans of similar value even if they have different coverage features.
  3. Why do my health plan options have high deductibles? Employees need tools to help them understand the workings of high deductible plans that are connected to HRAs or HSAs and why they may actually be the better choice for them. Employees also need help understanding how accounts work and the tax advantages of HSAs. Some employers enhance this transition by jump-starting the balance with a cash contribution.
  4. What are the differences among gold, silver, bronze, and safety net plans? The metal tiers mandated by the Affordable Care Act (ACA) for public exchanges (and adopted by many private exchanges) are designed to make it easier for people to compare plans but employees should delve deeper into the details beyond the metal hierarchy. Coverage, premiums and out-of-pocket costs vary by plan and insurer within the metal plans. Employees should make decisions based on a thorough comparison of plan details; they often need the help of decision support tools and live, personalized advice from an expert to do that.
  5. What do I need to do to earn my wellness dollars? Over 50% of enrollees say they will engage in wellness activities. They have many questions on how to earn wellness dollars, when they’ll have the money in their account, and what they can spend it on. This is good news for employers that have struggled to engage employees in wellness programs.
  6. How do I know if my doctors are part of the plan I choose? Being able to continue seeing their current medical providers is top of mind for employees when evaluating new health plans. However, answering this question can be a moving target as contracts among doctors, hospitals, and insurance companies can change from year to year. Exchange providers can make this complicated task easier by integrating doctor and facility lookup tools into the exchange enrollment experience. Many physicians are part of multiple plans, giving employees the choice of carriers and price points while still keeping their family physician.
  7. What are the difference among an HRA, HSA, and FSA? Health insurance is a complex topic with confusing jargon and acronyms. HRA, HSA and FSAs refer to the options employers have for funding health benefits through accounts that offer tax advantages to employees and employers for offsetting health care costs. These types of accounts have been available for some time, but are increasing in popularity as employers seek new ways to fund health benefits and encourage employees to save for health expenses.
  8. What does the prescription drug plan cover? Employees are confused by the array of pharmacy provisions, copays, coinsurance minimums and maximums, formularies, and more. They want to know what their drugs will cost for each plan and insurer option. In addition to using the decision support tools available, many employees want to discuss their circumstances with an informed service center representative.
  9. What are the differences between insurers? Confronted with different price points from different insurers for similar plan designs, employees want to know what added value they might be getting from a higher-cost insurer. While most insurers believe they do a good job of marketing and differentiating themselves from the competition, the prevalence of this question suggests there is more work to be done.
  10. If I want to keep the same plan I had last year, do I need to do anything? Historically, plans have had default rules that place employees in a predetermined safe plan choice if they don’t take action during open enrollment. In an exchange offering, some employers want to encourage an active enrollment choice each year so employees get to know the available options through a shopping experience. As employers offer more voluntary and ancillary benefits, employees should evaluate annually which of these to keep or change, as well.

Getting Service Right With a Private Exchange

If private exchange vendors offer the right level of consumer service, their platforms will create a revenue opportunity for carriers, brokers, and product partners in the coveted group market. But if they get it wrong, they’ll offer just another portal with a user ID and password, according to a report by Aite Group. Having an exchange platform does not negate the need for personal interaction to ensure the right plans are offered and employees are making the right decisions on tough, complicated issues. As employees face the daunting task of choosing their own benefits, vendors should consider a tiered support plan that allows employees to get help or go it alone. “Vendors must recognize the need to overstock the decision-support tool chest,” says Lindsey O’Connell, a research associate in Insurance at Aite Group. For more information, visit

The Growing Interest in Private Exchanges

Interest in private exchanges has sharply increased as the Affordable Care Act is officially underway, according to a report by the Decision Resources Group. The number of patients in consumer-driven health plans is likely to increase as private exchanges become more prevalent, which could have a negative effect on pharmaceutical sales, especially for branded drugs.

Decision Resources Group Analyst, AnnJeanette Colwell said, “Although there has not been mass movement towards these private exchanges, employers are interested in exploring these options. The increased interest in private exchanges provides an opportunity for managed care organizations to gain commercial enrollment, especially if employers begin moving their groups into single carrier exchanges.”

She said that when employer groups shift their workers into exchanges and use a defined contribution benefit model, employers will be more cost-conscious. Consumers are less likely to choose plans that significantly exceed their employers’ contributions. They are likely to choose a high-deductible option that has lower monthly premiums. For more information, visit

Private Health Exchange Survey in the Works


Initiative Brings Specialty Care to Rural Markets

Blue Shield of California and Adventist Health launched a telehealth initiative to increase access to specialty care in rural areas. Blue Shield members can be diagnosed and treated by specialists from across the state through interactive video technology available at a local Adventist Health site. Blue Shield individual and family plan customers, can seek specialty care that’s not available in their areas through the telehealth network — including those who purchased coverage through Covered California. Specialties include cardiology, dermatology, endocrinology (diabetes), pulmonology, rheumatology (arthritis), orthopedics, infectious disease, nephrology, gastroenterology, general surgery and spine surgery. The specialists are Adventist Health physicians who are contracted in the Blue Shield network. Patients can be referred by their local primary physician or can self-refer, make an appointment through a centralized care coordination call center, and go to their local Adventist Health location for their office visit.The Adventist Health sites are in the following cities in Covered California regions one and two: Paradise, Clearlake, Ukiah, Willits, Fort Bragg, St. Helena, Napa, and Sonora. For more information, visit

Private Health Insurance Exchange

Beginning in February, CaliforniaChoice is offering employers the ability to provide their employees with two metal tiers. The tiered-choice option offers employees greater access to health plans, benefits, doctors, specialists and hospitals. Available tiered-choice options include platinum and gold, gold and silver, or silver and bronze metal tiers. Each metal tier available through CaliforniaChoice also offers employees access to both full and limited provider networks. For more information, visit

Last Updated 05/05/2021

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