How to Get the Most Out of Your Employer Medical Plan

A job with good benefits is high on most employee’s list of needs, but actually taking advantage of them is another thing altogether. While it’s easy to opt for health insurance when open enrollment comes around, there may be other employer-offered benefits you could be maximizing.

Choosing the right coverage is essential to your health and finances, but work-life balance and mental well-being can be equally as important. Understand more about the different types of benefits to learn how to select what’s best for you and what you should take advantage of to make the most out of your employer-offered medical benefits.

Employment benefit packages often include health insurance as a job perk. These ensure employees have medical care they may need, such as routine appointments, treating illnesses and protection from unexpected healthcare costs. How it is offered, however, depends on the employer.

For instance, employers can offer organizational- or consumer-oriented benefits. If it’s organizational-oriented, you can opt in or out of their group health insurance policy. Conversely, consumer-oriented benefits mean you get to choose what health insurance plan you want and your employer will reimburse you. Taking advantage of these benefits is essential as the average cost of health insurance outside your employee benefits stands at $477 per month for a 40-year-old.

Sometimes, employers may not offer enough in the way of health insurance — which is why employees can also opt for individual medical insurance or personal health plans. An additional personal plan can help supplement employer benefits, depending on your needs.

To better understand your options, review the difference between employer health insurance and individual medical insurance.

Under typical employer-sponsored health insurance, the provider and plans are chosen by your employer. Premiums are split between your employer and yourself or paid for by your employer fully. If the payment is split, your share of payments is automatically deducted from your paycheck and can lower your taxable income.

Also called a personal health plan, an individual health policy is one that you can buy for you or your family outside of what your employer may offer. Depending on your needs, you can work with an insurance agent to compare plans.

Personal health plans can also be subsidized from the government if you are eligible for Affordable Care Act-compliant plans. If your income is between 100% and 400% of the federal poverty level, you may be granted premium tax credits.

The best health insurance plan is one that covers all your needs at a price you can afford. However, not all health insurance plans are cheap — even if you are sharing the costs with your employer or the government. Affordable health insurance often comes with lower coverage, which isn’t always the best option. Compare the options below to help you determine what may be the best plan for you and your needs.

There are various types of medical benefits available beyond health insurance employers can offer. This includes a health savings account (HSA), flexible saving account (FSA), preventative health care and more. Learning about the different benefit types your employer offers can help you find what suits you best.

Employers can offer a variety of health benefits, but you may miss these during your new hire onboarding. If you aren’t aware of what’s on the table, it’s important to reach out and ask your human resources (HR) department what health benefits they offer so that you can better protect your health and finances.

Employers can offer an HSA option. It acts like a savings account where you can contribute untaxed dollars to pay for deductibles, copayments and other expenses. However, you cannot use funds from your HSA to pay for premiums. In order to qualify for an HSA, you must be under 65-years-old and have a high-deductible health insurance plan.

HSAs are ideal for those who are generally healthy and want to save for future health care expenses, such as their deductible. It also benefits low-income individuals save just for their deductible, especially since they could have high-deductible plans.

An FSA is similar to an HSA — you get to make pre-tax contributions to a savings-type account to use for medical expenses — but it is far less flexible.

Unlike HSAs, your unused funds will not be rolled over into the following year, but some employers may grant a grace period of 2.5 months or allow you to roll over up to $570. This means that if you leave your employer, your contributed funds may be forfeited. On the other hand, employers can also make contributions to your FSA.

An FSA is best for those who are in good health and only want to save the minimum for their deductible, copayments or coinsurance. It’s also for employees who don’t have a high-deductible health insurance plan and cannot get an HSA, but still want a responsible entity holding on to their money for emergencies.

Employers may offer preventative care, also known as wellness benefits or routine care. This looks at their long-term health and aims to help prevent illnesses from developing or worsening. Preventative health care benefits involve annual check-ups, immunization, flu shots, boosters, tests, screenings and more.

Typically, your health plan should already include certain preventive health services for free — whether it’s from your employer or your own individual health plan.

Preventative care is beneficial for everyone — regardless of their age or health status. Being able to maintain and improve overall health and well-being through preventative care can ensure employees are in optimum health, productive and maintaining overall well-being.

If you’re unable to work due to a disability or illness, you may want to look into disability insurance. There are two types of disability insurance: short- and long-term plans and the coverage can help replace some of your wages. Typically, short-term disability plans last six to 12 months and benefits are given on a per-disability basis. A long-term plan, on the other hand, provides monthly benefits after a waiting period or if other benefits are no longer available.

According to the Bureau of Labor Statistics, around 30% of employers offered short-term disability insurance and 35% offered long-term disability insurance in 2020. However, accessibility varies by wage group.

Generally, disability benefits can suit any employee. After all, you never know when disaster may strike. It’s especially important for those who work in high-risk fields, such as construction, healthcare, agriculture and more.

Under the Family and Medical Leave Act (FMLA), if you work for a company with 50 or more employees, your employer is legally-bound to offer you up to 12 weeks of unpaid, job-protected leave per year for family or medical reasons. For instance, you can take unpaid leave for the birth and care of your child, to care for an immediate family member or to take a medical leave due to a serious medical condition.

However, to be eligible, you must have worked with your employer for at least 12 months, worked at least 1,250 hours in that period and have at least 50 employees in your company.

FMLA benefits every eligible employee. Employees are able to manage and balance their work and personal responsibilities in a timely and appropriate manner while securing their job during their leave. Since group health benefits are still maintained, any situation that occurs during the leave period can be covered.

Mental health care and work-life balance are important concepts in the workplace. Employers have begun offering a variety of lifestyle and wellness benefits to support and promote the well-being of their employees. In fact, in 2020, the 2020 SHRM Employee Benefits study found that 52% of employers offered general wellness programs. Recognizing these benefits can help you maximize benefits to improve your work-life balance.

Two in three adults say that money is a significant source of stress, which can affect your work performance and productivity. Some companies offer financial wellness programs which typically include information, training or support for an employee’s personal finance concerns. Lessons on budgeting, credit building, debt reduction and student loan repayment are a few topics that such programs can cover. These are given in order to minimize any financial challenges and reduce any money-related stress.

An employee’s mental health can affect their work performance. The Centers for Disease Control and Prevention note that depression can reduce cognitive performance 35% of the time, which is why employers may opt to offer mental wellness programs.

Mental wellness programs do not look the same at every company. Some companies offer mental health training for leadership, assistance finding therapists or provide dedicated relaxation rooms in the office where de-stressing is encouraged.

A sabbatical leave is where your company grants you a paid or unpaid “break from work” — typically several weeks off at a time — while safeguarding your work position. This is separate from your other paid time off (PTO) per year.

An employee’s eligibility for a sabbatical depends on the company’s policy. Some employers may require that you work at the company for a certain number of years before granting you this benefit.

Some employers offer lifestyle stipends — money given to employees for certain lifestyle purposes. For example, employers can offer a learning and development stipend to let employees improve their work-related skills. There are also stipends for family, food, travel and even pets. Eligibility for lifestyle stipends depends on your company.

These days, health insurance benefits are not enough. To keep employees satisfied, employers need to offer a more comprehensive health benefit plan, which often includes perks that go beyond just health insurance.

However, it can be easy to overlook the smaller benefits that come with your employer’s health package. Below are a few perks you may be missing out on.

Telehealth, also known as telemedicine, is where health care practitioners conduct patient appointments via phone or video conference. Depending on your employer’s chosen health insurance provider, you may get telemedicine or telehealth appointments covered.

Telehealth benefits are convenient, can get you an appointment sooner and may be more affordable. Both physical and mental health appointments are offered by many providers via telemedicine, affording you help when you need it.

It is not uncommon to face work-related stress or personal issues, but having it pile up can affect an employee’s performance over time. To help with this, some employers offer workplace counseling for free. This is a therapy option for employees seeking a safe place to discuss any issues they may be struggling with.

While counseling may not be for everyone, taking advantage of it can help maintain one’s health and well-being. It’s a short-term solution that focuses on problem-solving, which can be great if you’re looking for ways to cope with challenges.

Substance abuse can affect your overall well-being, which is why some employers offer substance abuse counseling through their wellness program. This is completely confidential and is offered to encourage you to reach out for help.

Note that patients who misuse drugs or other substances may need long-term care and employer-offered counseling sessions are only free up to a certain point. How many sessions you get depends on your employer. However, it’s a good place to start when you’re seeking help.

Learn more about health insurance, plans and options in the resources below to help you better understand your employer’s medical benefits.

• American Association of Retired Persons: If you need to calculate the cost of long-term care, this tool by the AARP can help you estimate the cost in your area.
• America's Health Insurance Plans: Learn more about America’s various health insurance plans through AHIP and get the latest news on all-things related to health.
• HealthCare.gov: Cost-sharing reductions: Understand how cost-sharing reductions work and if you qualify in this helpful resource.
• HealthCare.gov: Health coverage: Changing your current health plan can only be done if you have a life event. Use this tool from HealthCare.gov to see if you can still get coverage outside of the enrollment period.
• HealthCare.gov: Income levels & savings: Saving on health insurance is a must for low-income earners. anyone with low income. Find out if you are eligible for marketplace premium discounts, qualify for Medicaid or more based on your income using HealthCare.gov’s tool.
• HealthCare.gov: Marketplace plans: If your employer-sponsored health insurance is not enough and you want to switch to a marketplace plan, check out this guide to figure out what the switch entails and how to do it.
• HealthCare.gov: State options: To find out your state’s health insurance marketplace, use this tool from HealthCare.gov can help.
• Kaiser Family Foundation: Learn about employer-sponsored insurance and the numbers involved. How many employees get it? How much are premiums?
• Medicare: Find a plan: If your employer doesn't offer health insurance, but you’re interested in getting your own, consider Medicare. You can find and compare plans using Medicare’s helpful comparison tool.
• Medicare: Savings program: Understand the costs of different Medicare programs and how you can qualify for each one.