Gaps persist in plan sponsor, member views on benefits: Sanofi

While just half (49 per cent) of plan members said changes were made to their benefits plan in the past two years, 72 per cent of plan sponsors reported they made changes, according to the 2019 Sanofi Canada health-care survey.

More than half (51 per cent) of members said they didn’t know of any changes to their plans — which, the report noted, could mean either there were no changes or members were just unaware. In contrast, just 28 per cent of plan sponsors didn’t know of any changes to their plans.

Speaking at the survey’s launch event in Toronto on Tuesday, Barb Martinez, practice leader for benefits solutions, group benefits at the Great-West Life Assurance Co. and one of the survey’s advisory board members, said the results illustrate a gap. “We need to do more to communicate, that’s for certain, and we have more tools and technology to do that today.”

Read: 28% of U.S. employers made changes to health benefits in 2018: survey

Within the report, Dave Patriarche, president of Mainstay Insurance Brokerage Inc. and an advisory board member, agreed these gaps in awareness, especially among employers, is a concern. “This all comes down to communication — carriers, advisors and plan sponsors simply have to make sure that everyone understands what’s happening, and why it’s happening.”

Among plan members who were aware of changes, there were differing thoughts on their effects. Thirty-seven per cent said they thought better of the plan as a result, 30 per cent thought less of it and 33 per cent said they wanted to understand the impact of the changes. In comparison, more than half of plan sponsors (55 per cent) that knew of plan changes thought the plan was better as a result, 22 per cent thought less of the plan and 23 per cent wanted to better understand the impact.

The survey also found plan members are increasingly willing to pay more out of pocket for extra coverage and looking for more flexibility in their benefits plans. Three-quarters (74 per cent) of employee respondents said they’d like more flexibility and the option to trade off what and how much their plan covers. Interestingly, that percentage remained high for those who said they already had a flex plan, at 74 per cent.

“I think we’ve got more opportunities to share costs with members and that’s really coming through in the survey today,” said Martinez.

Read: More employers offering innovative health-care spending accounts: report

More than half (53 per cent) of plan members also said they’d be willing to pay more themselves to receive extra coverage, up from 49 per cent in 2014. Plan members in Quebec (62 per cent) and those with flex plans (60 per cent) expressed the most interest in this option.

“There seems to be a trend toward plan members’ willingness to contribute,” said Mark Rolnick, vice-president of payor partnerships and plan sponsor innovations at Health Solutions by Shoppers Drug Mart and a member of the advisory board. “Perhaps this is signalling that, as we think more about wellness and preventative solutions, there is an openness to a shared-cost or co-pay model, like most benefits plans, rather than employers having to cover all costs, as they do for an employee assistance program.”

Plan sponsors, too, were asked about their benefits plan wish lists. In ranking five potential improvements to their plans, 39 per cent said they want improved coverage options for high-cost specialty drugs, followed by benefits to prevent illness (36 per cent) and to help members manage chronic diseases (34 per cent). Employer respondents were slightly less interested in improved disability management (25 per cent) and fraud detection/prevention (19 per cent). 

Read: Growing use of specialty drugs putting pressure on plan sponsors: report

The survey also revealed some knowledge gaps in plan members’ understanding of how their plans work. Four out of five (83 per cent) plan members said they believe their employer pays a fixed cost to the insurance company regardless of how much or little the plan is used, and 48 per cent said they believe they’ll still be able to access their plan after retirement.

There was also a knowledge gap for both members and sponsors around automatic coverage of medical devices and certain medications. Six in 10 plan sponsors (62 per cent) and just four in 10 members (39 per cent) said they’re aware those services aren’t automatically covered by the plan and an employer may need to request coverage from the insurance company.

Plan members expressed some uncertainty around coverage maximums for certain benefits. The vast majority said their plan has maximums in place (66 per cent), while nearly a quarter (24 per cent) said they didn’t know. The remaining 10 per cent said their plan had no maximums. The knowledge gap shrank for plan sponsors, with 75 per cent saying their plans had maximums for certain benefits, 14 per cent saying there were no maximums and 12 per cent saying they didn’t know.

“I think that’s another area where we might be making changes, but not necessarily understanding the impact on members of maximums, or communicating those changes effectively to members,” said Martinez.

Read: The legal risks of drug plan design changes

Asked specifically about drug plans, 21 per cent of plan sponsors said they had a maximum in place, with the average sitting at $7,800. However, 55 per cent of plan sponsors said they didn’t know if their drug plan had a coverage maximum and just 11 per cent said it does.

The survey also noted a strong link between the health of plan members and their perceptions of their benefits plan, with members who are in poor health much less likely than healthy members to have strong positive feelings about their plan.

While overall, 54 per cent of plan members said they consider the quality of their health benefits plan to be excellent or very good, only 45 per cent of those who described their personal health as poor felt that way, in comparison to 67 per cent of those who said they were in good health. Only seven per cent of plan members overall described the quality of their plan as poor, but that number jumped to 19 per cent among plan members who were in poor health.

Read: How to communicate benefits to a diverse workforce

The survey also found plan design plays a role in member satisfaction. Plan members who had flexible plans and health-care spending accounts were more likely to say their plan was excellent, at 62 per cent and 61 per cent, respectively.

Plan members also stressed the importance of having a benefits plan. Three out of four respondents (76 per cent) said they wouldn’t move to a job that didn’t offer a health benefits plan, a finding that was relatively unchanged since 2015, the last time Sanofi asked the question.