As we approach the halfway point of 2024, individuals with group health insurance and Health Savings Accounts (HSAs) are likely starting to evaluate where they currently stand in regard to their annual deductibles and the balance in their HSAs. This mid-year checkpoint is crucial, as it helps employees understand their financial position and plan for the healthcare expenses they anticipate for the rest of the year.

Why Mid-Year Review Matters

The mid-year mark is a significant milestone for several reasons:

• Financial Awareness: Understanding how much of your deductible has been met can influence your healthcare decisions for the rest of the year. If you've met your deductible, you'll need full understanding of the co-insurance responsibility as you schedule necessary medical procedures or appointments, taking full advantage of your insurance benefits.

• HSA Balances: Reviewing your HSA balance helps you plan your healthcare spending. Since HSAs can be used to cover a wide range of medical expenses, knowing your balance, along with any medical service cost share, allows you to allocate funds appropriately for upcoming healthcare needs.

• Cost of Services: As deductibles reset annually, the remaining part of the year becomes critical for managing out-of-pocket expenses. Even after meeting your annual deductible, co-insurance is still impactful until you meet your out-of-pocket maximum. Employees need to be conscious of the costs associated with the healthcare services they plan to incur.

The Transparency in Coverage Rule

The Transparency in Coverage Rule was introduced to empower consumers to shop for healthcare services. Its primary purpose is to ensure that consumers have access to transparent pricing information, allowing them to make informed decisions about their healthcare, how their co-insurance with every service and how it impacts their overall deductible. Under this rule, any plan offering group health insurance is required to provide a consumer shopping tool to its members, that not only includes the cost of services, but any and all cost share as well.  Additional background on the rule can be found here.

Deerhold's PRIZM Shopping

Deerhold’s PRIZM Shopping is a robust solution that delivers this capability to several employer groups, allowing. PRIZM Shopping allows employees to confidently shop for healthcare services, ensuring they get the best possible price for the care they need. By leveraging PRIZM Shopping, employees can:

• Compare Costs: Access a comprehensive database of healthcare providers and services to compare costs effectively.

• Make Informed Decisions: Utilize transparent pricing information to choose the best healthcare options.

• Plan Cost Share: Understand current deductible remaining, co-insurance related to each service and out of pocket maximum. 

As we reach the midpoint of 2024, it is more important than ever for employees to be proactive about their healthcare spending. By reviewing their deductibles, managing their HSA balances, and utilizing available consumer shopping tools like PRIZM Shopping, employees can navigate their healthcare needs with confidence and financial prudence. The Transparency in Coverage Rule supports this process by mandating that all plans offering group health insurance provide these essential tools. Plan fiduciaries play a crucial role in this process by providing the necessary resources and reminders to help employees make the best choices for their health and finances.

If you're a plan fiduciary or working with plan fiduciaries, looking for a compliant and affordable healthcare shopping tool that delivers exactly what your members need to be confident healthcare consumers, contact @Pete Titas or @Scott MacEwen for a demo of Deerhold's PRIZM Shopping.