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what keeps hr tactical

August 23, 2009

in health communication

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the next time the discussion rolls around to the inevitable “hr must stop enrolling people and acting as employee liaison with the insurance company,” or that “employees must learn to be self-reliant”—ask those present to take a peek at your benefits communication.

do they read like this:

“the plan covering the patient as a dependent child of a person whose date of birth occurs earlier in the calendar year shall be primary over the plan covering the patient as a dependent of a person whose date of birth occurs later in the calendar year provided. however, in the case of a dependent child of legally separated or divorced parents, the plan covering the patient as a dependent of the parent with legal custody, or as a dependent of the custodial parent’s spouse (i.e., stepparent), shall be primary over the plan covering the patient as a dependent of the parent without legal custody.”

the above is lifted directly from a health insurance policy communication quoted in an editorial arguing for plain english in health communication. the editorial’s written by the executive counsel for the rhode island office of the health insurance commissioner, who fought to ensure that all state health policies are written at an eighth grade level. (ah, the irony. legal’s a typical culprit in adding this language!)

companies can’t alter some of the vexing elements of medical insurance, like pre-existing condition exclusions. but they can strategically rethink their health communications, not simply throw down the gauntlet of health care consumerism while hamstringing employees with impenetrable language.

when employees can’t understand their plans, they don’t use their benefits wisely. they make decisions based on incomplete if not inaccurate notions of how their plan works and what—and when—they pay for care. all too often they land in hr’s office, frustrated and scared about the jam they find themselves in. employees and managers look to hr to solve the problem, which translates into countless hours spent handling the minutiae for employees, even when benefits administration is outsourced.

if you’ve doubts about how even a simple downshifting in grade level can affect your communications, here’s how rhode island’s will soon read:

what happens if my spouse and i both have health coverage for our child?

if your child is covered under more than one insurance policy, the policy of the adult whose birthday is earlier in the year pays the claim first. for example: your birthday is in march; your spouse’s birthday is in may. march comes earlier in the year than may, so your policy will pay for your child’s claim first.

what happens if i am legally separated or divorced?

if your child is covered by your policy and also by the policy of your separated or divorced spouse, the policy of the parent with legal custody pays first. in other words, if you have legal custody, your plan pays first. the same rule applies even if your child is covered by a health insurance policy of a stepparent. for example: your former spouse has legal custody, and his/her new spouse’s policy covers your child. the new spouse’s policy will pay your child’s claim first.

of course, benefits communications rife with legal mumbo jumbo aren’t solely what keeps hr tactical and renders employees disinterested or ill-equipped health care consumers. they’re just not helping.


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