The Other Side of HR – part 1: Benefits

The blessing and curse of being an HR professional is that you get to be both an analyst of the day-to-day operation and a participant in it at the same time. Each interaction becomes an opportunity to learn something about the organization in order to help improve conditions for the people that work there — and for yourself.

For the rest of this month, The Buzz on HR is doing a series about the things I’ve learned on the other side of the HR equation, as an employee experiencing an event that happens to thousands of employees every day. Hopefully, some of this wisdom will rub off so we can all have more realistic expectations and make better decisions on the handling of issues.

Kicking off the series is my least favorite HR specialty: benefits! I’ve said before and I’ll say it again and again and again that there is really no winning for the employer in the benefits game. The insurance company is the house in this Vegas circus that is health benefits — and everyone knows the house always wins. All the employer can hope to do is provide benefits that are good enough for a large enough percentage of their workforce and try to educate their employees to be smart consumers. Everything beyond that is a gamble.

I rolled the benefits dice and crapped out about 3 years ago on New Year’s Day. We had just switched our major medical carrier and the effective date of coverage with the new provider was January 1st. And I came down with a raging case of strep throat on December 30th, finally couldn’t take it anymore and found myself in urgent care on New Year’s Day. Silly me had left my temporary id cards for our new carrier at the office, thinking I wouldn’t need them over the holiday.  The administrator at the urgent care was really nice about it, since I’d been to the facility before. She told me to call back as soon as possible with the new insurance information and I was able to be seen by the doctor with no problem. I was diagnosed, a prescription was written and I was on my way to the pharmacy about 30 minutes later.

However, without new insurance information at the pharmacy, I was screwed. The pharmacy couldn’t just give me pills — I had to provide insurance information right then and there or pay full price for the prescription, which was over $200!! Our office building was locked down for the holiday and I didn’t have the override code to get in. I called a couple of my co-workers to see if anyone either knew the security code or the new group number to our insurance company. But it was New Year’s Day so no one was really answering calls. The two people I talked with didn’t have the code or the cards.

I ended up buying a few pills to hold me over until I could get back into the building to get the temporary id card. I went back to the pharmacy and got the rest of my prescription — which turned out to be $35 cheaper than what I paid to get only a few pills! The pharmacy said they couldn’t reimburse me for the difference; I was going to have to take up that battle with the insurance company directly.

That’s when I got angry. I was angry at the pharmacy for not giving me back my money. I was angry at my company for switching to a new carrier. I was angry at the Healthcare System for making drugs cost so damn much! I was angry at my boss for forgetting to give me the access code so I could get into the building on holidays. Most of all, I was angry at myself for leaving the temporary id card in my office in the first place, getting sick, setting this sequence of events into motion, and for getting mad at everyone else when I was the only one to blame!

In that moment, I was reminded of all the times I had gotten a phone call from one of our employees who just started their benefits and showed up at their doctor or pharmacy without their insurance information. I remembered how exasperated I felt when they called me and how judgemental I was of their forgetfulness. I made a mental note not to do that anymore. And I made note of some other things too:

  • A lot of the mistakes in benefits are member error because we didn’t read the fine print of our plan summary. When this happens, own up to it. Don’t blame the insurance company or the employer when you mess up. It doesn’t help solve the problem.
  • Pay attention to the details and deadlines relating to benefits. Know when your coverage starts, changes or ends. Know what information in your introduction packet you need to hold onto and what you can discard. Know who and how to contact people about your benefits after hours. It is better to know or have it and not need it than to need it and not know or have it.
  • Build positive, cooperative relationships with your benefits people at both your employer and your insurance carrier. Automatically having a combative, demanding or negative attitude about everything that doesn’t go perfectly with your benefits is not productive. It also makes the benefits rep at your employer and the insurance company slow and/or unwilling to help. Express your frustration and disappointment without alienating the messenger.


Next week, the topic will be Employee Relations.






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