Health Insurance vs. Healthcare Costs: Finding Employee Benefit Gaps

Health Insurance vs. Healthcare Costs: Finding Employee Benefit Gaps

Think about the last healthcare expense that surprised you.

It might not have involved a hospital stay or major medical procedure.

Maybe it was dental work. Prescription glasses. Physical therapy. An executive physical. Acupuncture. Or another healthcare expense you assumed would be handled differently by your existing coverage.

Experiences like these highlight an important distinction:

Having health insurance and having help with healthcare costs are not always the same thing.

Understanding that difference can help employers identify opportunities to build a more meaningful employee benefits strategy.

Where Traditional Health Benefits Can Leave Gaps

A core health insurance plan plays an important role in an employee benefits package.

But employees experience healthcare in many different ways.

One employee may regularly need prescription medication. Another may have significant dental expenses. Someone else may need physical therapy, vision care, specialized testing, or fertility treatment.

This means the value of a benefits package can look very different from one employee to another.

For employers, particularly those thinking about benefits for executives and key employees, it is worth considering where those gaps exist.

What Could a Broader Health and Wellness Benefit Address?

A supplemental health and wellness program can potentially help with a wide variety of eligible out-of-pocket healthcare expenses.

For example, Sankaty Light's ExecSelect program identifies eligible expenses across categories including:

• Dental services
• Eye exams, eyeglasses, and contact lenses
• Hearing exams and hearing aids
• Lab exams and testing
• Executive physical examinations
• Acupuncture
• Fertility enhancement and treatment
• Prescription drugs
• Physical and occupational therapy
• Certain medical equipment and supplies

Some expenses have specific requirements, and potentially eligible expenses may require a Note of Medical Necessity from a healthcare provider. Plan documents and the Plan Administrator should always be consulted to determine eligibility.

The broader point is not that every healthcare expense is covered.

It is that employers may have more options for addressing healthcare costs than they realize.

Why Benefit Usability Matters

It is easy to evaluate employee benefits by looking at premiums, deductibles, plan designs, and coverage levels.

Those numbers matter.

But employees often evaluate benefits differently.

They remember what happens when they actually need care.

Was the benefit easy to understand?

Did it address something important to them?

Did it reduce an expense they otherwise would have paid personally?

Did they feel like their employer had provided something genuinely useful?

That is why benefit usability deserves a place in the employee benefits conversation.

Personalized Benefits for a Multigenerational Workforce

Today's workforce includes people with very different healthcare priorities.

A younger employee starting a family may have different needs than a senior executive managing an ongoing health issue. Another employee may prioritize preventive care, while someone else may have significant dental or vision expenses.

A one-size-fits-all view of value can struggle to address those differences.

Sankaty Light's approach emphasizes personalized plans that can help accommodate different employee needs and generations.

That flexibility can be particularly relevant when an organization wants to provide an enhanced benefit to a select group of key employees.

Ask a Better Benefits Question

When evaluating your benefits strategy, instead of asking only:

"What benefits do we offer?"

Try asking:

"Where are the gaps in what our key employees have today?"

That question can lead to a very different conversation.

It shifts the focus from adding benefits for the sake of adding benefits to identifying real healthcare needs and determining whether another approach could provide meaningful value.

For HR leaders, CFOs, CEOs, and business owners, that is an important distinction.

The objective is not simply to build a longer list of employee benefits.

It is to build a benefits strategy that people can actually experience.

Want to explore how a supplemental health and wellness program could fit into your employee benefits strategy? Visit sankatylight.com to learn more about working with Sankaty Light Benefits.