Why Zenefits Scares Me (It’s Not What You Think)

I recently decided to leave my position as Vice President at a national insurance agency and start my own agency, providing employee benefits to companies with up to 100 employees. When I left the corporate world, I left behind a nice benefits package, including group health insurance. Thankfully, my husband works for a small business that generously offers health insurance and covers 50% of his premium, something they are not required to do, but choose to do (I am assuming) to remain competitive and take care of their employees. They use Zenefits’ online platform, so their employees access benefit options and make elections online. Having read a lot about Zenefits and the perceived threat they pose to my role as a small group insurance broker, I was very curious to see what the Zenefits experience was like from the employee perspective. Here’s my experience as the spouse of an employee working for a company that uses Zenefits, and five reasons I think this type of service is doing more harm than good.

1. Too many choices. When my husband and I logged on to his company’s Zenefits website, we discovered that he had five health insurance options with the same insurance carrier – four PPOs and one HMO. For a company with less than 20 employees, that’s excessive. I don’t know if Zenefits recommended these plans or if they were already in place when Zenefits took over as Broker of Record. Either way, a good broker could help the company reduce the number of plans based on current participation to simplify the enrollment process.

2. No easy way to compare plans. The only plan information available on the company’s Zenefits website was the insurance carrier’s Summary of Benefits for each plan. Each summary is 6-10 pages long and some of the plan names are very similar, differentiated only by codes at the end of the names. There is no side-by-side comparison of the plans and no easy way to understand the plan differences. There was also no information about the provider networks attached to each of these plans. Printing out the plan summaries was the only way to compare plans, and that was tedious and confusing. Without a deep knowledge of plan designs, most people would not be able to make an informed decision with this limited information. A good broker would educate employees using plan comparisons, educational meetings and one-on-one conversations, to help them make informed decisions about their coverage.

3. Bad customer service platform. When I had a question about one of the plan benefits, I called the Zenefits support number provided on the website. I waited 15 minutes for someone to answer my call because of “higher than normal call volume.” When I was connected, it sounded like the representative was sitting in a large room full of people on phone calls, which made me wonder how private my conversation was going to be. Since Zenefits only provides customer service during business hours, most employees would have to call during their work day, which isn’t ideal for spending 15 minutes on hold or discussing personal health information.

4. Dismal customer service. When I did speak to a customer service representative, I had a very specific question about one of the plans, because the plan summary indicated that a physician visit could have a co-payment or co-insurance, but didn’t indicate why each would apply. The person I spoke with didn’t know the answer, put me on hold, and returned to tell me that the procedure code that the doctor used when billing the insurance company after my visit would determine whether I had to pay a co-payment or co-insurance, and that I should contact the doctor for that information. I pointed out that it would be unlikely that a doctor would know the procedure code for a visit before the visit, and that the doctor wouldn’t know how much the insurance company would bill me. So it would be very difficult for me to know the cost of a visit before my visit. This is certainly part of a bigger issue with healthcare billing, but I got very little help from customer service and would not have known how to proceed if health insurance wasn’t my business.

5. More dismal customer service. Once I selected a plan, I noticed that the Summary of Benefits posted on the Zenefits portal was dated 1/1/14, more than a year ago. I knew my husband’s company had gone through open enrollment earlier this year, so I expected that the summary would be updated to 2015. When I asked the customer service representative if I was looking at the most recent summary, he couldn’t tell me, and surmised that either the carrier hadn’t updated the summary since last year or that the online information was outdated (neither of which he could confirm). When I asked how I could be sure I was looking at the current information, he suggested I go to the carrier website, find the summary for the plan I was considering, print that out and compare all 10 pages, side-by-side, with the one on the Zenefits portal “to see if there are any discrepancies.” A good broker would make sure employees had the most up-to-date information, and be able to explain any differences in plan design from year to year.

6. Incorrect rates. Zenefits had the wrong monthly rates loaded in the employee portal, which is the only place my husband and I could get information about the available plans. Since Zenefits handles everything online (so simple! so easy!), there was no in-person benefit orientation when he came on board, and there was no one to double-check the accuracy of the deductions once he made his election. As a result, the first two months of deductions that Zenefits made from my husband’s paycheck through their payroll system were incorrect, and they had to go back and make additional deductions to fix the error. Worse, he noticed that the deduction amount for our medical insurance went up without notice, and had to contact his employer, who in turn had to contact Zenefits for an explanation.

Zenefits has been creating a huge disruption in the broker community, because their technology platform and cost-structure are appealing for small employers. But there’s a bigger problem here for employees, and this is why Zenefits scares me: health insurance can’t be self-service. It’s complicated and constantly changing. It has huge financial and medical implications for the people being covered. When employees (or their spouses) have questions, they need help from someone who has more knowledge, resources and customer service skills than the cable or cell phone companies. Helping people understand how their health insurance works and how to use it effectively can affect real change in the health care industry. From what I’ve seen, Zenefits is not making a positive contribution to that effort.