Explain premiums, cost sharing and coverage checks through contrasting household scenarios. Improve communication, enrollment confirmation and payroll accuracy.
September 14, 2026 · Financial Forte Staff
Historical article: prepared retrospectively using information available as of September 14, 2026.
Open enrollment can overwhelm employees with detailed documents while leaving the central question unanswered: how will this choice work for my household? A premium table is useful, but it does not show whether a prescription is covered, a preferred clinician is in network or a higher deductible fits the employee's cash reserves.
Organize communication around a few meaningful decisions and provide a reliable path for individual questions. Explain the trade-offs without steering every employee toward one plan. Clear education can improve the value employees receive from benefits already in the budget while reducing avoidable enrollment errors and repeated HR inquiries.
Show total cost without pretending to predict care
Separate payroll premiums from costs paid when care is received. A deductible, copayment, coinsurance amount and out-of-pocket maximum serve different roles. The maximum generally applies under the plan's rules to covered services; premiums and excluded or out-of-network costs may fall outside it.[1]
Use the Summary of Benefits and Coverage and the actual plan documents to explain these distinctions. A simplified comparison should point employees to the controlling terms rather than replace them. Verify that the premium amounts correspond to the employee's coverage tier and payroll frequency.
Do not present last year's claims as a promise of next year's needs. They can help identify recurring prescriptions or care patterns, but an employee may face a new diagnosis, planned procedure or family change. Encourage a comparison of ordinary use and a more expensive year, along with the practical ability to pay early-year bills.
Use contrasting household examples
Compare two hypothetical employer plan options. Plan A costs the employee $150 a month, has a $3,000 deductible and a $6,000 out-of-pocket maximum. Plan B costs $300 a month, has a $1,000 deductible and a $3,500 maximum. For this illustration, assume the relevant care is covered and in network, and do not assume the two plans have identical service rules.
Annual employee premiums are $1,800 for Plan A and $3,600 for Plan B. Under a low-use scenario, assume the employee's additional covered-care costs are $600 under A and $300 under B. Total annual employee cost would be $2,400 under A and $3,900 under B, a $1,500 difference in favor of A under those assumptions.
Under a different scenario in which covered in-network cost sharing reaches each plan's stated maximum, premiums plus that cost sharing would total $7,800 under A and $7,100 under B. B would be $700 lower in that comparison ($7,800 less $7,100). Those totals are not absolute limits on every possible medical expense; excluded services and other costs can change the result.
An employee expecting little care might focus on the premium saving, while someone with ongoing treatment may give greater weight to the higher-use comparison. Another employee may prefer a lower deductible because a large early bill would be difficult to fund, even if the expected annual total is higher. These are different circumstances, not evidence that one employee understands benefits better than another.
The employer should also show whether it contributes to an HSA or other arrangement and how those funds may be used, when applicable. Do not mix employer and employee dollars or assume every employee is eligible for every tax-favored account. The details belong in the actual plan comparison.[2]
Make coverage details easy to verify
Give employees a short preparation list: clinicians, facilities, medications, expected procedures and any dependent coverage changes. Explain where to check networks and formularies for the coming plan year. A familiar insurer name does not establish that every plan uses the same network or drug coverage.
Provide contact information for questions requiring a plan-specific answer. HR can explain the enrollment process, while the insurer or administrator may need to confirm coverage details. Employees should know who will help if the directory, plan document and telephone answer appear inconsistent.
Make information available through channels employees can actually use. Remote staff, shift workers and employees who prefer paper or need language or accessibility support may not be served by one live presentation. Review applicable disclosure and accessibility requirements with the benefits team and provide practical alternatives and a way to confirm the materials were received.
Protect privacy during education. Employees should not have to disclose a diagnosis or family financial difficulty in a group meeting to obtain help. Offer a private route for questions and limit the information shared with managers to what is needed for administration.
Close the loop after the election
State the actual enrollment deadline, how to submit an election and how to confirm it was accepted. Explain what happens if an employee takes no action under the specific plan, rather than assuming every benefit renews automatically. Some accounts or elections may require an active choice.
Before the first payroll of the new coverage period, reconcile elections, coverage tiers and deductions with the administrator. Assign an owner to each discrepancy and resolve missing or conflicting records promptly. A clear presentation will not prevent frustration if the elected coverage and payroll deduction do not match.
For an ERISA health plan, fiduciary responsibilities include prudent administration and appropriate oversight of service providers. Review fees, services and unresolved problems as part of that process. Education should accurately reflect the plan and should not promise a coverage result the documents do not support.[3]
Measure whether the communication worked using enrollment completion, error rates and recurring questions. A confusing phrase that generates dozens of calls is an opportunity to improve the next message. That is a practical way to raise the value of the benefit without simply increasing employer spending.
Start this year's communication with one comparison showing premiums, two care scenarios and the steps for verifying a household's providers and medications. Pair it with an accessible support contact and a clear confirmation process. Employees will have a more usable decision than a stack of unexplained plan summaries.
Related reading
Have more questions about employee benefits communication and open enrollment? Email Dave at dave@financialforte.com to discuss your questions and next steps.
The contact invitation is current; it does not imply this contact path existed on the historical reference date.
Educational information, not personalized investment, tax, legal or benefits advice. Examples use hypothetical assumptions. Verify current rules and your circumstances before acting.
Sources
- [1] CMS Glossary of Health Coverage and Medical Terms — 2016-era uniform glossary; predates 2025 reference dates
- [2] IRS Publication 969: HSAs and Other Tax-Favored Health Plans — January 13, 2025; 2024 edition
- [3] Understanding Your Fiduciary Responsibilities Under a Group Health Plan — September 2023
