A benefit nobody explained is a benefit nobody can use. In KFF’s 2023 survey, 51% of insured adults called at least one part of their insurance hard to understand. Someone on your team may be holding an employee benefits package they can’t fully describe, and without an HR department, the explaining usually lands on you. The list of what everyone needs to hear is short.
What does every employee need to hear about their benefits?
Five short messages, repeated at the right moments, give employees enough to act on without the paperwork in hand. All five fit in a sentence or two.
- What the company covers. The benefits you offer and the share of the premium you pay.
- What the employee pays. The paycheck deduction, the deductible, and the copays.
- Who to call. The carrier for claims, the office for paperwork, and Mark when the carrier’s answer falls short.
- When changes are allowed. Open enrollment, plus life events such as a new baby.
- Where the written details live. The summaries, kept somewhere every employee can find them.
Say them in that order at the start, and keep the wording the same every time after that. Among adults with employer coverage in the KFF survey, 40% found what’s covered hard to follow. Another 34% said the same about what they’d owe, which makes those the first two messages on the list.
KFF puts the employer share of a family premium at about three-quarters, and workers contributed an average of $6,850 toward that premium in 2025. You’ve paid most of the cost. That’s a lot to spend on a benefit an employee may not know how to use.
How do you explain benefits through the situations employees face?
Tying each benefit to a moment an employee may live through gives each benefit a shape worth remembering. An employee can know every benefit by name and still not know whom to call when a baby is due. With a situation attached, the next step is clear.
Federal rules take the same approach. The Summary of Benefits and Coverage (SBC) is the short summary that group health plans give enrollees. It has to include coverage examples for common situations, such as pregnancy and serious or chronic conditions.
A benefits translation puts each situation beside the step to take and the person to call.
| Situation | What the employee should do | Who to call |
|---|---|---|
| A baby is on the way | Tell the office right away and ask for the date by which the baby must be added to coverage | The office for enrollment, the carrier for what’s paid toward the delivery |
| Surgery means time away | Ask the insurer whether the surgery needs approval before it’s scheduled, then ask the office how time away is handled | The carrier for approval, Mark if the carrier stalls |
| An unexpected bill arrives | Compare the bill with the statement sent after the claim, before paying | The insurer, then Mark if the answer doesn’t settle it |
Three rows cover a good share of what employees ask. A fourth row for a question your own team raises often takes ten minutes to add.
When a baby is on the way
A newborn can be added to coverage within a window the written documents spell out, so the dates belong in the conversation before the due date. The SBC’s pregnancy example estimates what a person might pay for a delivery. That gives an expecting employee one number to budget around.
When surgery means time away from work
A planned procedure raises two questions at once. One is whether the procedure needs approval, and the other is how the paycheck holds up during recovery. The insurer answers the first, and you answer the second. That’s the moment to mention Short Term Disability, if you offer it.
When a bill arrives that nobody expected
After a claim is processed, the insurer sends a statement showing what it paid and what the employee owes. Checking the bill against that statement is step one, and a call to the insurer is step two. Mark steps in when a claim is denied or an approval is delayed.
How do you explain HSAs, FSAs, and voluntary benefits in plain words?
Each comes down to who pays, who keeps the benefit, and what happens to anything left unused.
Health savings account (HSA). An HSA belongs to the employee and stays with them after a job change. It pairs with a high-deductible health plan, so it fits only the employees enrolled in one.
Flexible spending account (FSA). An FSA holds paycheck dollars set aside for health costs. The employee usually has to spend them within the plan year.
Voluntary Benefits. The employee picks the benefit, such as Life Insurance or Short Term Disability. Payroll deduction usually covers the cost.
Choosing the right mix is a decision you and Mark make together, with the numbers side by side. His post on how Voluntary Benefits strengthen employee retention covers the budget side of that choice.
What do you have to put in writing for employees?
Employers with a group health plan owe employees two written summaries, one on rights and obligations and one on benefits and costs. The summary plan description (SPD) is the document that explains an employee’s rights and obligations. Federal law sets its reading standard in a single line.
“written in a manner calculated to be understood by the average plan participant”
The SBC does a similar job in four double-sided pages or fewer. Its wording has to be understandable by the average enrollee. Employees can request one at any time, and it’s due within seven business days.
A one-page note repeating the five core messages, kept beside those summaries, gives employees an answer on their own time.
When should you bring benefits up with your team?
Three moments bring benefits up naturally, and each calls for a different conversation.
At hire. The five core messages and the written summaries belong in the first week, before the first question arrives.
At open enrollment. Mark recommends giving employees at least two full weeks inside the window, with summaries written in plain English. His open enrollment checklist for small businesses puts each step on a calendar.
After a life change. A new baby, a marriage, or the loss of other coverage gives an employee a reason to ask. The answer comes easier with the benefits translation in hand.
Talk it over with a benefits advisor
Employees feel looked after when someone explains their benefits in plain words. Mark has helped employers choose and explain benefits since 2001, and his work doesn’t end once the paperwork is done. Reach out to our team about your situation, and together we’ll turn your benefits into messages your employees can use.