Have you recently enrolled or been offered enrollment in a group healthcare plan through your employer? If so, this can be a great way to enjoy benefits for yourself and your loved ones. Of course, when enrolling in group healthcare (or any health care plan, for that matter), making sure you’re making the most of your benefits is a must. By following a few steps, you can make that happen.

Understand Your Plan

member-benefits-groupFirst and foremost, make sure that you understand every last detail of your plan. This will require you to obtain a copy of your benefits from your employer. As you read through your benefits, pay special attention to certain factors, such as:

  • your co-pays and deductibles
  • waiting periods you may be subject to
  • possible dental and vision benefits
  • physician choice

By knowing the details of your coverage, you’ll be less likely to run into unpleasant surprises down the road (such as high out of pocket costs for a particular procedure).

Always Think Ahead

All too often, once an employee has successfully enrolled in a group healthcare plan, he or she forgets about it—until a medical problem arises and he or she needs to use it. Waiting until you’re facing a medical problem to ask questions about your coverage is a recipe for disaster. Instead, be proactive and ask important questions as soon as you have them.

For instance, in the event that you’re injured while out-of-state on vacation, will it be possible for you to find care outside of your coverage area? And if you’re admitted for a hospital stay, is there a limit as to how many days your insurance will cover?

Make Sure Your Plan Can Adapt

Life is unpredictable, but it’s important to do everything in your power to make sure your group healthcare plan can adapt to your changing needs over the years. For example, how will your benefits change if and when you get married? Have a child? What if you get divorced down the road? Knowing what to expect from your healthcare benefits in these situations now will help better prepare you for inevitable changes in your life.

Denied Claims: What to Do

Finally, if you run into any issues with your healthcare provider, you should be aware of the proper procedures and protocols to follow. For instance, you should know that you have a right to receive a decision regarding your claim within a specified time period; if your claim is denied for any reason, there is a specific series of steps you can follow to file an appeal. Your benefits manager can help you explore these steps if necessary.

Making the most of your group healthcare benefits requires some proactive thinking and effort on your part, but it’ll be more than worth it down the road. If you’ve missed your group enrollment deadline or are losing coverage, there may still be an opportunity to enroll in individual coverage. Join us for a webinar to discuss options and how you may be able to qualify for a special enrollment period.


If you’re an employer with at least five employees, contact us to learn how you can enroll in the Private Health Exchange program to offer benefits to your staff. Let Member Benefits walk you through the process today. You can also watch our recent webinar discussing the Private Health Exchange.