Perspective: Health Plans Cannot Rely on EOCs and ANOCs Alone to Explain Coverage Changes

6/6/2023 Cindy Thomas

For health insurance companies, the season for Explanations of Coverage (EOC) and Annual Notices of Change (ANOC) is fast approaching. Savvy leaders recognize the additional need for a strategy to prevent member disenrollment and dissatisfaction over necessary plan changes. 

Plain and simple, member satisfaction requires communication beyond EOCs and ANOCs to ensure changes are not only communicated, but comprehended. Obviously, these communications will happen within the CMS timeline requirements. Here are a few things to consider as you communicate changes to your members later this year.

Add variety to how you communicate

Your product teams work hard to build attractive plan components, but it takes an extra effort to ensure that your members are not only aware of this hard work, but also understand where and how it may impact their lives. 

At this year’s RISE CMS Bid Boot Camp, attendees were encouraged to recognize that members are at risk to switch plans or issue a complaint when any of these occur:

• Changes that are hard to understand
• Difficulty understanding plan rules
• Price increases
• Benefit reductions
• Changes to covered drugs or provider networks

We recognize EOCs and ANOCs as obvious and mandatory table stakes for how health insurers address plan changes with their members. Go beyond the basics throughout the entire year to communicate information that will have an impact on members. Member retention begins with your welcome kit strategy.

Speaking at this year’s Medicare Market Innovations Forum, the CEO of GS National Insurance shared that nearly two-thirds of members switched plans because they didn’t fully understand the details and benefits within their coverage.

Think inside the box

One example of going above and beyond would be the concept of a “benefits box.” Similar to a care kit, a benefits box is bespoke and designed to show members the depth and breadth of their plan. At RRD, we see this concept as one that drives collaboration between health plans and supplemental benefits companies. The outcome:

• A special welcome to the plan in the form of a box that introduces members to what is included
• Increased use of supplemental benefits 
• Heightened awareness of the value of the plan (for better retention) 
• Additional opportunities for sustained member engagement 

Giving members the support they need to successfully interpret complex information may also address and prevent member disenrollment and poor CAHPS scores. Contents of the benefits box can include the following:

• Useful samples associated with each supplemental benefit (e.g., electric toothbrush, eyeglass cleaning kit, recipe cards, over-the-counter card)
• Easy-to-read brochures explaining what is covered under a specific benefit, co-pays, and out-of-pocket expenses
• Clearly defined value of supplemental benefits to members should utilize 
• Explanations of co-pays and out-of-pocket expenses
• Streamlined access to a provider list
• If an OTC card is included, simplified directions for use, specific rules, and use restrictions should accompany it

A kit like this can help overcome challenges related to communicating — and the comprehension of — coverage changes. Also, it is possible that your supplemental benefit partners may have an interest in sharing the cost and creation of a benefits box project.

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In addition to a benefits box, other available member touchpoints to consider as you communicate coverage changes include:

• Explainer videos or infographics that explain the changes in a visually appealing way. This can be helpful for members who learn best by seeing or doing.
• Emails or text messages that notify/remind members of upcoming changes. This will help to ensure that members are aware of the changes before they take effect.
• Social media posts or informative blogs that explain the changes in a way that is easy to understand. This can be a great way to reach a large number of people quickly.
• Telephone calls or in-person meetings with members to answer any questions they may have. This can be helpful for members who need more personalized assistance.

By utilizing a variety of communication methods, health insurance companies can effectively cover all the bases to ensure members are not caught off guard by unexpected changes.

Cindy Thomas is the Director of Payer Business Development for RRD Healthcare Solutions.