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Medical Insurance and Language Barriers

Columnist: Rosario Avila
November, 2017 Issue

Rosario Avila
All articles by columnist

Tengo Seguro medico, pero no se como usarlo! Or, as we say in English—I have medical insurance, but don’t know how to use it. The employee benefits world can be confusing, and providing information in an unfamiliar language only adds another obstacle, making it difficult to understand and use. With so many types of medical plans and employer arrangements, it’s no wonder Hispanic employees would rather go to a local clinic or emergency room than use the medical benefits given to them by their employers.

Many issues that contribute to the underutilization of employee benefits come from lack of understanding in the Hispanic community. And despite the literature provided in Spanish, insurance terminology is a language all its own. In many Latin American countries, universal health care is the norm. Walking into any local clinic for a same-day appointment for any illness, and walking out with a prescription or treatment plan, is all some employees know. When these same employees are presented with the opportunity to enroll in complicated and bewildering employer-sponsored medical plans— such as an HDHP PPO with an HSA—they tend to feel intimidated and shy away from using them. (If you’re reading this, chances are you’re also unsure as to their meanings, so imagine what it’s like if English is your second language. The acronyms alone are overwhelming and confusing, and the information they represent even more so.) Most benefit carriers understand the importance of having benefits explained to employees in their own language, but straight translations are never enough.

When it comes to education, it’s not only important to speak the language, but to explain the terminology. A perfect opportunity to clearly define terms and ensure better usage of benefits is during your company’s open enrollment meeting. And though meeting one-on- one with employees is great for a personalized explanation, group settings can be just as beneficial, depending on how the benefits are presented. Using terms such as: deductibles, out-of-pocket maximums, networks, and coinsurance is not sufficient information on its own, and causes confusion. Explaining what these words mean and how they affect an employee’s pocketbook as well as giving examples of specific situations, is more impactful and facilitates open dialogue.

When we ask employees how they locate in-network providers or seek care for preventive services, the response we hear most often is through word-of-mouth. Employees tend to ask co-workers, friends, and family where they seek services, and will go to the same place without regard to their insurance network or benefit structure. This causes additional confusion when the employee receives a billing statement from the provider, showing that insurance didn’t cover the services because they weren’t from an in-network provider, or the amount was applied to the deductible. Employees then question the coverage, but instead of calling the broker or asking their employer for assistance, they decide it’s too costly and don’t seek services again until the need is serious. Sometimes it’s too late. Providing critical information should be a top priority. For example, it’s important to let employees clearly know that preventive care is covered at 100 percent when seeing an in-network provider. For example, annual checkups, annual OB/GYN visits, mammograms and colonoscopies (at certain age attainments) are covered 100 percent. This saves employees money, and may also help with early detection of many serious illnesses.

Employers often feel at a loss when attempting to facilitate understanding and use of medical benefits with their Spanish- speaking employees. Two simple and effective steps to overcome these barriers include:
1. Inviting a representative directly from the carrier to your next open enrollment meeting. This not only ensures a comprehensive description for your Spanish-speakers, but also allows for more education on plan usage and benefits. This is especially important if you offer a type of reimbursement plan, or employer contribution towards the deductible or first-dollar services.
2. Involving and educating spanish-speakers at open enrollment time by including spouses and family members at the open enrollment meeting. Community input is an important part of decision-making in the Hispanic community. Your employees will feel more comfortable having their spouses or adult children listening to how their employer benefit options are handled, and are more apt to ask questions. In the Hispanic community, family reliance is significant. Family members feel more at ease relying on each other for information as opposed to “burdening” their co-workers with questions and asking for explanations.

Remember, the goal is for employees to understand that insurance is a benefit, not a hindrance. And the more rapport your employees can build with your insurance broker, the more trust they’ll have in using their health insurance.

Rosario Avila is a benefits consultant and head of the Spanish language division at Arrow Benefits Group in Petaluma. She has worked in the employee benefits industry for more than 15 years. Rosario can be reached at, or at (707) 992-3795.



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