Employer Benefits

How to Explain New Health Benefits to Employees During Open Enrollment

Reviewed by Erik Osborne, PA-C, Co-Founder | October 13, 2026

The Quick Answer: Employees make better benefits choices when you explain what each part of the benefit does for them, in the order they will use it, before enrollment opens. That matters because 35% of employees regret the choices they made during their last open enrollment, and while 46% feel confident managing their benefits, only 23% say they genuinely understand them [1]. If your 2027 package adds Direct Primary Care (DPC) and a cost-sharing layer, a simple three-part explanation, repeated across several short touchpoints, does more than a long benefits guide sent once.

Important: Direct Primary Care is a membership arrangement with a doctor for primary care services. It is not insurance and doesn’t meet ACA minimum coverage requirements on its own. Health sharing and cost-sharing plans are not insurance. Sharing of medical costs among members is voluntary and is not guaranteed the way payment is under an insurance contract.

You did the hard part. You looked at your renewal, compared the options, and built a 2027 benefits package that gives your team better access to care at a more predictable cost. Now comes the part that decides whether it works: explaining it.

The stakes are real on both sides. Average family premiums for employer coverage reached $26,993 in 2025, up 6% from the year before [4], and small-group insurers proposed a median 14% increase for 2027 [5]. A better-designed benefit only pays off if employees understand it well enough to choose it and use it.

Why Benefits Communication Breaks Down During Open Enrollment

Most benefits communication fails for three predictable reasons.

It arrives at the wrong time. Only 20% of employees say benefits communications consistently reach them when they are ready to act [2]. A thick guide sent the day enrollment opens competes with every other deadline on their desk.

It defaults to inertia. Roughly 90% of employees usually pick the same plan as the prior year, according to a Voya Financial survey reported by HR Morning [3]. A new structure asks people to break that habit, so it needs more explanation, not less.

It explains features, not situations. Employees do not think in terms of deductibles and Initial Unshared Amounts. They think, “What happens when my kid gets an ear infection?” or “What if I end up in the ER?”

The Three-Part Framework: Explain the Benefit in the Order Employees Will Use It

When your package combines DPC with a cost-sharing layer and an employer contribution, give employees one mental model and repeat it everywhere.

Part	What it is, in plain language	What employees use it for	How often they will use it
1. Your doctor (DPC)	A membership with a primary care practice for a flat monthly fee	Sick visits, checkups, chronic condition care, texting or calling the doctor	Often; this is the everyday layer
2. Big-event protection (cost sharing)	A community that shares eligible large medical costs above an Initial Unshared Amount (IUA)	ER visits, surgery, hospital stays	Rarely, but it matters most when it happens
3. Your employer’s contribution	The money the company puts toward the package, structured with your advisor	Paying for the layers above, depending on plan design	Every month, usually automatically

If your contribution runs through a CHOICE Arrangement (Custom Health Option and Individual Care Expense Arrangement, formerly ICHRA), explain it as an allowance: the company sets aside a fixed amount each month, and eligible costs are reimbursed tax-free under the plan’s rules. Your advisor can confirm exactly what your CHOICE Arrangement can and cannot reimburse, and that detail belongs in your written materials.

How to Explain Each Piece in Plain Language

Use short, situation-based language. Here are sample scripts you can adapt for meetings, emails, or a one-page summary.

Explaining Direct Primary Care: “Starting January, you’ll have your own primary care doctor through a membership the company helps pay for. You can call or text the office, get same-day or next-day appointments in most cases, and you won’t get a bill or copay for covered visits. It’s not insurance. It covers primary care, not hospital stays or surgery.”

Explaining the cost-sharing layer: “For big, unexpected medical events, like an ER visit or surgery, you’ll be part of a cost-sharing program. You pay the first portion of each eligible event, called the Initial Unshared Amount, or IUA. Eligible costs above that are shared by the community under the program’s guidelines. This is not insurance, and sharing is not guaranteed the way insurance payment is, so please read the member guidelines.”

Explaining what changes and what stays the same: “What changes: how you see a doctor for everyday care, and how large bills are handled. What stays the same: you can still get care when you need it, and our advisor is available to answer your questions one-on-one.”

Explaining why the company made the change: “Our old plan’s cost was going up again next year. We chose a structure that gives you more direct access to a doctor and gives the company more predictable costs, so we can keep offering meaningful benefits.”

An October Open Enrollment Communication Timeline

If your plan year starts January 1, 2027, this sequence works for most small and mid-size employers:

Four weeks before enrollment: announce the change. Send a short note from leadership explaining what is changing and why. Keep it under 200 words.
Three weeks before: send the one-page summary. Use the three-part table above. Add a list of situations (“If you get sick…”, “If you need surgery…”) and who handles each.
Two weeks before: hold a live session. A 30-minute meeting with your advisor works better than a slide deck. Record it for remote staff.
One week before: offer one-on-one time. Employees with ongoing conditions, pregnancies, or high prescription needs should talk privately with an advisor before choosing.
During enrollment: send two short reminders. One at the midpoint and one two days before the deadline.
After enrollment: send a “how to use it” guide. Include how to reach the DPC office, how to submit a large medical need, and who to call with questions.

What to Say, and What Not to Say

Clear, accurate wording protects both your employees and your company. These swaps come from the same principles regulators use to review health benefits marketing.

Avoid	Say instead
“This replaces your insurance.”	“This works alongside a coverage layer for major medical events.”
“Everything is covered.”	“Here is what each part is designed to handle, subject to its terms.”
“You’ll definitely save money.”	“Many employees may pay less; your costs depend on how you use care.”
“The health share will pay your bills.”	“Eligible costs above your IUA are shared under the program’s guidelines; sharing is not guaranteed.”
“It works the same everywhere.”	“Rules can vary by state; ask our advisor about your situation.”

The Questions Employees Will Ask (and How to Answer)

“Can I keep my current doctor?” Maybe. If your doctor is not part of the DPC practice, you can still see them, but those visits are not part of the DPC membership. Encourage employees to meet the DPC practice first.

“What if I have a pre-existing condition?” Be direct: cost-sharing programs often have waiting periods or limits for pre-existing conditions. Route these employees to a private conversation with your advisor before enrollment.

“What about my prescriptions?” Many DPC practices offer medications at wholesale pricing, but coverage of specialty drugs varies. Have employees bring their medication list to a one-on-one.

“What happens if I’m pregnant or planning to be?” Maternity rules vary by program. This is another one-on-one conversation, not a group-meeting answer.

“Is this cheaper for me?” Give real examples, not promises. Show what a typical sick visit, a routine year, and a large medical event look like under the new structure.

Frequently Asked Questions for Employers

How far in advance should we communicate benefits changes? Start about four weeks before your enrollment window opens. A single announcement the day enrollment opens rarely gives employees enough time to understand a new structure.

What is the best format for explaining benefits to employees? A mix works best: a short leadership note, a one-page summary, a live session with Q&A, and one-on-one time for employees with complex health needs. Only 20% of employees say communications consistently reach them when they are ready to act [2], so repetition across formats matters.

Do employees need to understand every detail before enrolling? No. They need to understand what each layer is for, what it does not cover, and where to get help. Detailed guidelines should be available, but the core message should fit on one page.

Should we mention that Direct Primary Care and cost sharing are not insurance? Yes, clearly and early. Accurate expectations build trust and reduce surprises later.

Can our advisor present at our open enrollment meeting? At Journey Health Advisors, we regularly join employer enrollment sessions to explain the structure and answer questions directly.

Next Steps

A well-designed benefits package still needs a clear explanation to succeed. The employers who get the best results treat open enrollment as a short communication campaign, not a single email.

At Journey Health Advisors, we help employers design and explain benefits that combine Direct Primary Care, cost sharing, and CHOICE Arrangements, with no carrier bias and no pressure. If your enrollment window is coming up, we can help you build the one-page summary, join your enrollment meeting, and hold one-on-one sessions with your team.

Speak with an advisor at Journey Health Advisors: 1 (844) 580-6055 | journeyhealthadvisors.com/contact

Related Reading:

REFERENCES

[1] Selerix. “Selerix Releases Second Annual Employee Benefits Survey.” Selerix, June 2026. https://selerix.com/blog/selerix-survey-2026/

[2] Selerix. “Take the Guesswork Out of Open Enrollment.” Selerix, September 2026. https://selerix.com/blog/take-the-guesswork-out-of-open-enrollment/

[3] HR Morning. “Employees Don’t Understand Benefits: 6 Fixes for Open Enrollment.” HR Morning, September 2026. https://www.hrmorning.com/articles/understand-benefits/

[4] KFF. “2025 Employer Health Benefits Survey.” Kaiser Family Foundation, October 2025. https://www.kff.org/health-costs/2025-employer-health-benefits-survey/

[5] KFF. Analysis of preliminary 2027 small group rate filings (summary on KFF premiums research page). KFF, 2026. https://www.kff.org/tag/premiums/

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