Inclusivity in employee benefits: DE&I concerns in plan design and communication

As companies embrace diversity, equity, and inclusion (DE&I) efforts, many are realizing their benefit policies and communications can help address health inequities and be more inclusive. From modernizing the language in plan documents, to simplifying fertility care for same-sex couples, to not showing a skinny marathoner in the ads for your fitness challenge, Milliman’s Chief DE&I Officer Christal Morris joined Employee Communication Consultant Heidi tenBroek and Health Actuary Stephanie Peterson to discuss how plan sponsors can help make sure all beneficiaries get the care they need.

Transcript

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Heidi tenBroek: Hello, and welcome to Critical Point brought to you by Milliman. I'm Heidi tenBroek. I'm a principal and employee communication consultant, and I'll be your host today. In this episode of Critical Point, we're going to talk about DE&I considerations in benefits and communications. Since it's Pride Month, we'll look at LGBTQ+ issues—things like referring to “parental leave” rather than “maternity leave.” But we'll also talk about other ways that benefit programs and policies can address equity concerns and be more inclusive.

Joining me today are two of Milliman's top experts in this subject: Dr. Christal Morris, our chief DE&I officer. Hi, Christal.

Christal Morris: Hi, Heidi.

Heidi tenBroek: And Stephanie Peterson, who's a principal and consulting health actuary in Milliman's Health and Group Benefits practice. Hi, Stephanie.

Stephanie Peterson: Hi, Heidi.

What do we mean by health equity and DE&I?

Heidi tenBroek: It's great to have you both with me today. I'm going to start off by asking a question to Christal. Christal, to set the stage for our discussion and make sure we're all on the same page, would you kick things off by talking a bit about what we mean by health equity and DE&I for purposes of our conversation today?

Christal Morris: Absolutely. Such a great question. So, to set the stage, when we talk about health equity, you know, even the Centers for Disease Control and Prevention (CDC) describes it as, “The state in which everyone has a fair and just opportunity to attain their highest level of health.” So, what that really means is, as a consumer of health, that I, Christal, have an opportunity to see a doctor that is accessible, that provides compassionate healthcare, that understands my needs, and that I have an opportunity to ensure that my health is prioritized.

And then when we talk about DE&I, and of course there are tons and tons of definitions of this, but to put it in its simplest form, diversity is really any difference that separates one person from another. It's everything from the way we communicate to how we learn to our religious practices to ethnicity and gender and just all the different dimensions of diversity that make people different.

And of course, equity in the sense of health is about that parity in healthcare as we just described, but it's also just ensuring that people are treated fairly and equitably according to what their needs are. So, not equality, but equity. What are their specific needs?

And then when we think about inclusion, inclusion is about making sure that you are prioritized, that your voice is heard, that people understand what your needs are. And that maybe you're included in the decision-making about your health, making sure that your needs, your voice, your thoughts, your perspectives are prioritized, and thinking about how you are accommodated from a health perspective.

So, thanks for that question, and I think the next question we'll pose is to Stephanie. Stephanie, based on your observations, what are employers and plan sponsors most focused on these days when it comes to these important issues?

Health plan sponsors increasingly focused on DE&I concerns

Stephanie Peterson: Thanks, Christal. This is definitely something that plan sponsors are focusing in on. Ever since the pandemic and COVID-19, there's been a lot more attention drawn into DE&I benefits and effort. So, no matter where a person is at—where they're located, who they are, their ethnicity, their age, their gender—that we're able to provide them with benefits that make sense and that meet the needs of themselves as well as their families.

We actually have a National Business Group on Health survey that we received, and it actually highlighted some of the things around what plan sponsors will be focusing on as it relates to health and equity for 2023. There's going to be a lot more focusing in on marginalized and underserved and under-resourced populations within their workforces. So, plan sponsors are going to continue to put forth focus on social determinants of health through their health and well-being programs, emphasizing healthcare access, finances, and needs, as well as childcare needs.

According to the survey, plan sponsors will also continue to address health inequities by expanding coverage and benefits for those diverse populations as well as those that are transgender individuals. You know, interestingly enough, there's also been some increased recognition for making disability a key part of these DE&I initiatives. So, making sure you're open to hiring all types of individuals with disabilities. And make sure to create an accessible workplace for those folks regardless of where they're at or where they're located. Making sure they can get to their respective workplaces.

And last but not least, the plan sponsors are also planning to prioritize women's health and in very specific ways around reproductive care. So, expanding fertility care, not only for heterosexual couples, but also for same-sex couples. And what does that mean? And they're also looking at addressing maternal mortality for underserved or under-resourced populations and increasing coverage for those things like doula services and things like that that they can leverage to make sure they have a healthy pregnancy and healthy babies. So, lots going on for 2023. And I only expect this shift to continue forward going into 2024 and beyond.

So, I'm going to switch it over now to Christal and ask Christal the question of: How can plan sponsors learn more about what their folks really need and value?

How can companies learn what benefits their employees need?

Christal Morris: Thanks, Steph. I think I'm going to answer this from a DE&I perspective. I really love leveraging our employee resource groups (ERGs). So, internally at Milliman, we have about seven employee resource groups, and I think getting people to think about different aspects of benefits and how their communities and their families need to be supported, just hearing those different perspectives, is really important.

So, one example is, we've leveraged our Pride, which is our LGBTQ+ ERG, to really help us think through different LGBTQ+-inclusive benefits. And it was our Pride ERG that helped us recognize at Milliman that when we think about adoption benefits, which are primarily, as you just mentioned, designed for heterosexual couples, it’s really important to think about all of the people who may want to adopt and what adoption benefits really look like. And so, it was that ERG that really helped us think through both adoption and how we modify our policy to accommodate people across the spectrum of sexual orientation and also our fertility benefits as we think about people who potentially want to have a child. That is not always for heterosexual couples. So, it's really important to think through how you might leverage your employee resource groups to help shape and inform a strategy for benefits from a plan sponsor perspective.

It's also important to think about how you might just take a cohort of people that have a different set of perspectives and design surveys or design focus groups to help shape and inform what people really need and value, both from a generational standpoint and from an age standpoint. I personally, myself, am a caretaker and I'm constantly thinking about the needs of my mother. So, whether or not you're thinking about what flexibility looks like, what caregiving benefits look like, it's just really important to think about the whole person as you think about how you can put together the most inclusive benefit package for your employees.

And so, with that, I'm now going to pose a question to Heidi. Heidi, what kinds of things do you highlight in benefit communications to make them more inclusive?

Transportation, health status, and other barriers that prevent people from accessing benefits

Heidi tenBroek: Thanks, Christal. I just think it's so important what you were just talking about in terms of talking to your people and really understanding their needs and their perspectives. And that is all absolutely key to bring into your communications about benefits.

So, talking about ideas for overcoming barriers to using the plan. A lot of times if you think about perhaps employees at different income levels in your plan, maybe just getting to their appointment is tough. But perhaps you have ways to provide a little more flexibility on how people can take their leave, or maybe there are resources available for just transportation to getting to their appointments, or things like that. So, really thinking about what are the barriers and challenges that people face in terms of accessing their benefits and proactively sharing that kind of information to help remove those barriers or help people overcome them.

And things like, in terms of different perspectives, consider the health status of your folks. Lots of people have wellness programs. Maybe they have a step challenge. Well, folks who maybe have multiple chronic conditions, they may not be really in a place where they can participate in your step challenge. But there are other things they can do to move along on the journey towards a healthier life and making sure that you are communicating in that way. That not every picture is somebody who's a marathon runner. Not every example is somebody going out and doing a zillion steps. But showing the way for many different kinds of people, you know, when you're doing that communicating or when you're talking about tips for being a better consumer and managing your healthcare. Using examples of things that's realistic for people, and acknowledging that there are certain things that people can't do.

One of the things that we've been talking about quite a bit lately is the idea of highlighting certain benefits. So, if you think about, maybe your organization has gone down the path and has a great suite of LGBTQ+-friendly benefits, but they're buried in the summary plan description (SPD) or in legalese or “insurancese.” And people may not feel comfortable asking their manager about those, or even going to Human Resources (HR) to ask like, "What does this mean and do we offer this?" Don't make them hunt. You know, don't make them work so hard at it. Get out there and proactively advertise those benefits and do it in a way that is very easy to understand for people who don't do benefits all day every day like some of us do. Those provisions can be pretty opaque, even for those of us who are in the business. So, really dig in, explain it clearly, and then proactively and regularly advertise those benefits. I think that's very important.

Christal Morris: Heidi, that was great. Thank you so much. I'm actually going to have Steph elaborate just a little bit more. So, Steph, what other specific kinds of changes are you seeing in health plan coverage to address these needs?

Plan sponsors rethinking fertility, adoption, and other benefits

Stephanie Peterson: We are seeing a lot, actually. [laughs] There is definitely a lot happening in this space, you know, and even I think from the basic premise of access to care, affordability, accessibility, based on an employee's location or whether they can afford it or not. I mean, those are things that are all coming to the table and the forefront of what plan sponsors are looking into.

I would say the top three, though, from what we're seeing specifically for plan sponsors, are around fertility, infertility, and probably even encompassing adoption and surrogacy. I know that the goal is to have a fertility program that addresses all types of family structures. Whether you're, like we said, a heterosexual or a same-sex couple. So, having a program that does offer the option to adopt if you want. It used to be under fertility programs that you had a waiting period before you could even qualify for infertility benefits. Those are also things that are being considered in terms of, is that necessary? Is it necessary to have that in place for two males? Same-sex couples? And then also from the perspective of adoption and benefits around adoption. You know? Paternity- and maternity-type benefits and leave and everything around that. And so, I think there's a lot around making sure that all is equal and all is fair within the realm of fertility, whoever you are. And so, that's definitely been top of many plan sponsors’ minds.

Transgender benefits have been a bit controversial, right? But I think that the idea is that we want to make sure that everybody has the same options and the same ability to live how they want to live. And I think many plan sponsors are identifying with that in our space. So, making sure you understand when you're offering transgender benefits, what level of care do you want to cover and then to what extent. There's a whole slew of options for how far you want to go with it in terms of what plan sponsors are willing to cover. And there's also the cost associated with it that has to be accounted for as well. We cannot ignore the cost of that as well. You know, high on the topic of considerations is, should they be putting any age limitations in there and what is their philosophy around that? I mean, that's probably more company-specific. But we've seen it from young to old. And so, it can really just depend on what that plan sponsor, what their overall objectives are and their overall goals when they offer transgender benefits. And just really to make sure that we can erase any sort of inequities around that so that they can get the same care as someone who is not getting that transgender adjustment.

Telemedicine helps access for mental health, substance use concerns

Stephanie Peterson: And then last but not least, I was going to highlight mental health/substance abuse support. Making sure that everybody has equitable access to providers and specifically in-network providers. And given that there may be certain providers in certain areas and then none in other areas. And this has been a challenge, not only for health and equity and DE&I, but just overall, making sure that we have the right people out there to address the needs and the mental health and substance abuse needs for employees across all companies.

I would say that there's been a lot more virtual options offered in this space because of that. And you can make sure that maybe there's more of an alignment with who you feel comfortable with as well. So, you could see somebody that's of the same culture that you're from. And they understand your background and where you're coming from and how you feel. And that kind of makes you feel like you're more willing to say, "Yeah, that's somebody that I can relate to and I definitely like seeking treatment in that way." And that way it's a comfort level. So, there is a lot more virtual options that are coming into the mix that gives you more options around more than what's available to you potentially from where you currently reside.

So, yeah, there's a lot going on this space, and just making sure that you have the right care, whoever you are. You know? And it shouldn't matter. You should be able to have access to any type of care that you need.

I'm going to switch it up and I'm going to ask Heidi something that has been of great interest to me is: Part of what drives some of this is how we communicate the basic HR and the basic benefits information to plan participants. Do you have any tips in doing that? Because I think that's probably one of the most important places, so people know about it. People understand it and they know where to go.

How to communicate benefits so all beneficiaries feel included

Heidi tenBroek: Thanks, Stephanie. I really appreciate that because this is a topic near and dear to my heart. And just riffing off of what you were just talking about in terms of people being able to access providers that feel comfortable to them and that they connect with, whether that's behavioral health, or any kind of health. Part of that is making sure that we get people to all of the great work that folks like you do in terms of making sure that those networks are robust, and that they're culturally appropriate providers or providers that serve specific needs. All of that's in vain if the plan participants don't know how to find those people. So, even just educating people that that work is being done on the network side, and then how to dig into those provider network search tools to find the people that are going to work for them. So, part of it's just education around highlighting the great work that plan sponsors and consultants are doing to enhance these benefits, and enhance the access, and just make sure people know how to do it.

But I mean, kind of back to what I mentioned earlier, is just making sure that you're thinking about all the various different kinds of people that are in your organization and that you're showcasing those people. So that when they come and pick up, say, a plan newsletter or they go to the benefits website that they feel like they belong. That they feel like these benefits have been designed for them, and so that means really showcasing a variety of people and circumstances.

Make sure plan documents avoid heteronormative language

Heidi tenBroek: And then I would say, in general, when you're just in terms of your writing, just in terms of the language, things like including details only if they're relevant. You know, you don't have to say, "The female CEO," unless it's relevant to what you're talking about, right? You can just say, "The CEO." So be careful about including too many details. You know, if it's not relevant, ditch it. And the same with parallel language. You know, you don't say, "The female CEO" unless you also want to say, "The male CFO." Like, is her gender really relevant? And if it is, make sure you're being parallel. Or that you're using titles in a parallel way.

And then I know that it's a good idea, too, to look at forms and policies. So, maybe you have a beautiful benefits newsletter that you're really proud of and is presenting your benefit program as you want, but then somebody digs one layer deeper and your leave policy only talks about married people or spouses and doesn't talk about domestic partners or maybe those things—the ones that people look at less often. And there may be some language in there where people just kind of come to a screeching halt and say, "Wait a minute, this isn't the organization that they're advertising kind of on the outside."

So, making sure you dig into that next layer deep and look at your policies and look at forms. You know, do you actually need all of the information you're requesting? Do you need to ask for somebody's gender? Is it critical to the form that—you know, the information you're gathering? So, get rid of things that aren't absolutely necessary. You know, hunt down instances of heteronormative language or outdated language. So, those are some of the things that I would recommend, kind of broad-brush, that we do from a communication perspective.

“Empathy is critical”: Thinking of all your different types of employees

Stephanie Peterson: And Heidi, we've also been seeing some things around—because there's been so many remote workers now—that there's been a lot more email messages, home mailings, webinars, and chats, and things like that that kind of cater to that population as well, because they historically would have been going to their open enrollment meetings, right? Their annual enrollment meetings. Getting the information from there. But it's interesting how this maybe evolved for some—not all, because some have to be in the distribution centers, for example, for retailers. They have to be there, right? But then you have a lot of the corporate folks that don't.

Heidi tenBroek: Yeah, it's really highlighted that awareness of your remote workers, too. And we've always had remote workers, or have for many, many years.

Stephanie Peterson: Right.

Heidi tenBroek: And I think they were sort of treated like second-class citizens or forgotten that they were—everybody's like, "Oh, we're having lunch in the office today," and send the message out for everybody.

Stephanie Peterson: Mm-hmm, mm-hmm.

Heidi tenBroek: And those people are kind of left in the corner. So, I think that's an important point, that when we are talking about, thinking about all the different types of employees and participants, it's endless. You know, think about your remote workers versus your in-the-office. And I think that really just comes down to empathy, you know?

Stephanie Peterson: Right.

Heidi tenBroek: Empathy's critical in thinking about what works for people. And I would say that just in general—and Christal mentioned this at the top—of different learning styles. You know, having a robust communication strategy means presenting things and sharing information in many different ways, because we've always had multiple generations in the workforce. We've always had people in the same generation who learn differently. And so, presenting information and sharing information in multiple ways is just critical, I think.

Christal Morris: Yeah, I think what you two were talking about is why it's so important to have that inclusion lens, particularly as you're thinking about benefits. Even from, as you think about communication, PowerPoints, presentations, accessibility. Are you using closed captions? And then you get into a bunch of other things around accessibility and making sure that people have the ability to hear and learn in the way that's appropriate for them. We could probably talk about this all day, there's so much that goes into inclusivity as you think about benefit offerings.

Heidi tenBroek: Oh, I think that's a wonderful note to end on. Thank you for that, Christal, that's just fabulous. Thank you both, Christal and Stephanie, for joining me today. You can learn more about our employee benefits work at Milliman.com.

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