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Throughout the year, employees are likely to run into issues with their benefits. These may include denied claims, billing issues, or coverage questions. While plan details and coverage vary by insurer, employees often encounter similar concerns regardless of their plan. Some may be due to employee benefits, while others may be due to system or human error. According to a 2026\u00a0report from Gitnux<\/a>, almost 80% of medical bills contained at least one error, including duplicate charges, spelling errors, and incorrect codes, which can cause inaccurate billing or confusion. Billing errors, denied claims, inaccurate information, and other coverage obstacles can create pain points for employees.<\/p>\n By addressing these pain points, employers can help employees understand their benefits and set clear expectations. Keep in mind that the most accurate response will vary by employer, depending on the type of benefit, the plan\u2019s details, and the employee\u2019s specific situation.<\/p>\n Here are five common benefits-related issues employees encounter, along with ways employers can help navigate them.<\/p>\n Unexpected medical bills are one of the most common employee concerns. Employees often assume that if they have health insurance, they won\u2019t owe anything for care. However, even with insurance, employees may receive medical bills for a variety of reasons, such as:<\/p>\n To prevent surprise medical bills, employers can encourage employees to review their explanation of benefits (EOB) to understand what and how much insurance covers. If the bill does not correspond with the EOB, the employee should contact the provider or carrier, as the issue may be related to provider billing or claim processing. In addition, providing year-round benefits education is an effective way to manage employees\u2019 expectations. For example, they may not realize that out-of-pocket costs are still common with insurance, especially early in the plan year.<\/p>\n Under the Affordable Care Act, most health insurance plans and issuers must cover a set of recommended preventive services conducted by an in-network provider at no cost to insureds. However, coverage details (e.g., visit frequency limits or which screenings are included) may vary by insurance company or plan, affecting how a visit is billed. Charges for preventive visits may occur when:<\/p>\n Employers can encourage employees to take the following measures to ensure their preventive care is covered:<\/p>\n If employees receive an unexpected bill for their preventive care visit, they can ask for an itemized bill to review charges and consult their health care provider or insurer about any errors.<\/p>\n Providers that are in an insurance network are typically covered under that carrier\u2019s plan. Unfortunately, seeing an in-network provider doesn\u2019t always guarantee insurance coverage. In fact, a KFF report found that 19% of 496 million claims were denied in 2024. Factors that may lead to a denied claim include:<\/p>\n Employees should contact the carrier to understand the reason for their claim\u2019s denial and determine whether it can be corrected or appealed. As part of benefits education, employers can emphasize that plan rules, such as authorization requirements, apply regardless of network status.<\/p>\n When employees have a benefits-related issue or feel like their benefits aren\u2019t \u201cworking,\u201d they may feel overwhelmed and unsure who to go to for answers. Employers may offer several types of benefits\u2014such as medical, dental, vision, and voluntary benefits (e.g., accident, critical illness, disability insurance)\u2014each administered by different carriers and subject to different rules. As a result, employees may not know which benefit they need to address.<\/p>\n That\u2019s why it\u2019s important for employers to provide contact information and benefits resources in a centralized location. This can help employees identify the appropriate contact, reduce frustration, and help them resolve their issue quickly. Easy and clear guidance can also prevent overloading HR or benefits teams with unnecessary escalations.<\/p>\n Dependent eligibility issues can be stressful for employees. After all, if a dependent individual isn\u2019t eligible under their plan or they miss deadlines, that dependent may be without coverage for the upcoming plan year.<\/p>\n Several circumstances, including the following, can make a dependent ineligible for coverage under an employee\u2019s plan:<\/p>\n Employers should clarify their plan\u2019s dependent eligibility requirements and emphasize the importance of reporting status changes and promptly submitting documentation. Furthermore, they should inform employees of their coverage continuation options for when a dependent loses eligibility. Under federal law (i.e., the Consolidated Omnibus Budget Reconciliation Act), dependents may be able to continue coverage for up to 36 months, and state law may also offer some form of continued coverage. Employees should contact HR as soon as a qualifying midyear eligibility change event occurs so that they can begin these processes.<\/p>\n Benefits issues can be complex and overwhelming for employees, as they often impact both their finances and health. Although employers cannot prevent every issue, they can play a key role in helping employees navigate their benefits by explaining plan rules, managing expectations, and guiding them to resources.<\/p>\n By proactively addressing common pain points, employers can reduce confusion and frustration, improve the benefits experience, and enhance the effectiveness of their benefits plans.<\/p>\n \u00a9 2026 Zywave, Inc. All rights reserved.<\/em><\/p>\n Frustrated with your current employee benefits provider? The\u00a0local employee benefits team at GTM<\/a>\u00a0is here to help you find the right plan to fit your budget and excite your employees. GTM\u2019s employee benefits design skills, cutting-edge technology, and expert HR support can help you streamline and automate processes, reduce your costs, and relieve administrative burdens, all while delivering benefits that will delight your workforce.<\/p>\n Let the\u00a0GTM Insurance Agency<\/a>\u00a0help you create and implement a competitive, customized, and cost-effective benefits package for your employees while reducing the burdens and costs of managing benefits on your own.\u00a0Get a free quote<\/a>\u00a0today.<\/p>\n","protected":false},"excerpt":{"rendered":" Learn five common employee benefits-related issues your employees may encounter and how you can help navigate them.<\/p>\n","protected":false},"author":7,"featured_media":0,"comment_status":"closed","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"_et_pb_use_builder":"","_et_pb_old_content":"","_et_gb_content_width":"","footnotes":""},"categories":[232],"tags":[20,16,30],"post_folder":[],"class_list":["post-18435","post","type-post","status-publish","format-standard","hentry","category-gtm-biz-blog-isolved","tag-employee-benefits","tag-employees","tag-health-insurance"],"_links":{"self":[{"href":"https:\/\/gtm.com\/business\/wp-json\/wp\/v2\/posts\/18435","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/gtm.com\/business\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/gtm.com\/business\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/gtm.com\/business\/wp-json\/wp\/v2\/users\/7"}],"replies":[{"embeddable":true,"href":"https:\/\/gtm.com\/business\/wp-json\/wp\/v2\/comments?post=18435"}],"version-history":[{"count":4,"href":"https:\/\/gtm.com\/business\/wp-json\/wp\/v2\/posts\/18435\/revisions"}],"predecessor-version":[{"id":18448,"href":"https:\/\/gtm.com\/business\/wp-json\/wp\/v2\/posts\/18435\/revisions\/18448"}],"wp:attachment":[{"href":"https:\/\/gtm.com\/business\/wp-json\/wp\/v2\/media?parent=18435"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/gtm.com\/business\/wp-json\/wp\/v2\/categories?post=18435"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/gtm.com\/business\/wp-json\/wp\/v2\/tags?post=18435"},{"taxonomy":"post_folder","embeddable":true,"href":"https:\/\/gtm.com\/business\/wp-json\/wp\/v2\/post_folder?post=18435"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}1. \u201cWhy did I get a bill from my provider when I have insurance?\u201d<\/h2>\n
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2. \u201cWhy did I get charged for preventive care?\u201d<\/h2>\n
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3. \u201cI checked that my provider was in network. Why was my claim denied?\u201d<\/h2>\n
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4. \u201cWho do I call if something goes wrong?\u201d<\/h2>\n
5. \u201cWhy isn\u2019t my dependent covered anymore?\u201d<\/h2>\n
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Conclusion<\/h2>\n
GTM is Your Ideal Employee Benefits Partner<\/h2>\n