Plan member wish list – what coverage do plan members really want

Welcome to the fourth of our seven-part Sanofi Insights – a series of articles created to provide you with insights into highlights of the 2020 Sanofi Healthcare Survey results.

Understanding how plan members rate the different coverage provided under their group benefits provides key insight plan sponsors need to look forward. Plan members are looking for products and services that will help prevent chronic illness, alleviate stress and anxiety, and allow them to operate at their optimal level. Of course, plan sponsors want the same thing to avoid unnecessary absenteeism, presenteeism, and claims. Of the type of coverage available, the 2020 survey results revealed that vaccines are the top choice for new coverage by both plan members and plan sponsors.

Pre- and post-COVID-19 coverage wish list

For plan members, the desire for preventative products and services like fitness classes, health risk screenings, and virtual care follow closely behind vaccinations. Plan sponsors also report being supportive of health risk screenings but chronic disease management is also at the top of their list.

There is a distinct upward trend (from 35% in 2016, to 58% in 2020), of chronic disease conditions that can cause plan members to miss work. Given the prevalence of chronic disease in the workplace , it’s surprising that plan members rate the opportunity for help in the management of these conditions towards the bottom of the list. Perhaps this is the link to how plan sponsors can prioritize chronic disease management as a plan enhancement.

Prior to COVID-19, telehealth was primarily leveraged for high volume situations and for rural, isolated regions. But the pandemic has pushed us to think differently about using virtual services. The same trend is apparent with prescription and certain paramedical services. The pandemic has also highlighted the importance of good mental health. More and more, plan sponsors are asking for the inclusion of mental health services and support.

Coverage trade-offs

Another interesting question within the survey asked plan members if they could increase coverage for a benefit type, which one it would be.  The question immediately following asked which benefit type they would be willing to reduce as a trade-off for the higher coverage in another area. Both answers were consistent with the answers received in the 2017 survey.

• The #1 choice for increased coverage was major dental services including orthodontic care
• The #1 choice for decreased coverage (for a trade-off for coverage somewhere else, was overwhelmingly, paramedical care

Plan sponsors may want to take the pulse of their plan members in order to gain a better understanding of potential trade-offs. 

Finding alignment

A best practice would be to establish a committee, made up of plan members, the plan sponsor, and an advisor, which would be better equipped to find alignment between stakeholder needs and the bottom line. Surveying the needs of plan members would help identify the unique desires of each respective organization. In this framework, it would be prudent for plan sponsors to work with their advisors to recognize and address the gaps. Capable advisors will help shed light on other funding arrangements, flexible spending accounts, and where plan sponsors could spend and save.

While plan member needs may not have changed post-quarantine, the pandemic has forced companies to evolve, look forward, and think outside the box which could ultimately align their needs with the needs of their plan members. Best practice would be to implement good governance for the purpose of considering all stakeholders, survey the benefits landscape, thoroughly review funding arrangements, and prepare for a world of virtual service providers.

Written by Jamil Jamal, Consultant at People Corporation, with insight provided by Shannon Darvill, Consultant at Silverberg Group, a People Corporation Company, and a Sanofi Canada Healthcare Survey Advisory Board Member.