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AIPROPX ReportFortune · 3h ago
The Benefits Activation Gap: what claims data teaches us about employee engagement
Every claim tells a story.
Sometimes it’s about an employee recovering from a serious illness. Sometimes it’s about a family navigating the loss of a loved one. Sometimes it’s about protecting financial stability after an unexpected disability.
But from where I sit leading claims operations, claims often reveal another story—one that begins long before a claim is ever filed. Too often, employees discover they don’t fully understand the benefits they’ve elected, overlook coverage they already have, or realize too late that they declined protection they now wish they had.
Those experiences have led me to think differently about employee benefits.
I call it the Benefits Activation Gap : the disconnect between enrolling in benefits and confidently using them when life happens.
Employers invest significant resources in designing competitive benefits programs that support the health, financial security, and wellbeing of their workforce. Yet the value of those investments isn’t determined during open enrollment. It is realized months—or years—later, when an employee faces one of life’s most challenging moments and knows exactly where to turn for support.
From a claims perspective, the Benefits Activation Gap is surprisingly visible.
What Claims Data Reveals
Claims operations offer a unique window into how employees engage with their benefits. Every day we see where employees understand their coverage, where confusion exists, and where opportunities for better education emerge.
Patterns become apparent over time.
Organizations that communicate with employees throughout the year—not only during open enrollment—often experience more consistent utilization of benefits. Employees receive reminders about what they elected, understand how their benefits work, and know how to begin the claims process when they need assistance.
We see this firsthand with one large healthcare employer that regularly highlights voluntary benefits, explains available resources, and reinforces how employees can access them. Claims activity remains steady throughout the year because employees have an ongoing connection to the benefits they’ve chosen.
Other organizations experience a different pattern.
Claims frequently increase immediately following open enrollment as employees remember they have coverage, discover benefits they had forgotten about, or realize they never submitted claims for services they were eligible to receive. These aren’t isolated events. They point to a broader challenge: awareness fades when benefits conversations occur only once a year.
The lesson isn’t that employers need elaborate communication strategies. It’s that employees are far more likely to use their benefits when those benefits remain visible, understandable, and relevant throughout the year.
Enrollment Is Not Activation
Open enrollment has traditionally been viewed as the defining moment in the benefits experience. It’s certainly an important one.
Yet enrollment represents a decision—not engagement.
Employees are asked to evaluate life insurance, disability coverage, accident insurance, critical illness insurance, hospital indemnity plans, and other voluntary benefits within a relatively short period of time. Many are making decisions while balancing work, family responsibilities, financial pressures, and an overwhelming amount of information.
Expecting every employee to retain those details months later, during one of the most stressful experiences of their lives, isn’t realistic.
Activation happens after enrollment.
It occurs when an employee remembers that disability coverage can replace income during a medical leave. It occurs when a family understands how life insurance can provide financial protection. It occurs when someone knows how to access an Employee Assistance Program, teletherapy, or other wellbeing resources before a challenge escalates.
Those moments determine whether benefits fulfill the promise employers intended when they invested in them.
Benefits Build Trust Long Before a Claim
One of the most important lessons claims teaches is that trust isn’t established when a claim is approved.
Trust begins much earlier.
Employees develop confidence when they understand their benefits, know where to find information, and believe help will be available when they need it. Every positive interaction—from educational resources to a straightforward claims experience—reinforces an employer’s commitment to supporting its people.
When employees discover coverage gaps only after a life event, the experience is very different.
Some assume they enrolled in coverage they never selected. Others passed on voluntary benefits without fully appreciating their value. By the time a claim is filed, those enrollment decisions can’t be changed.
Those moments underscore why benefits education should be viewed as an ongoing investment rather than an annual event.
Closing the Activation Gap
Closing the Benefits Activation Gap doesn’t require employers to redesign their benefits programs or dramatically increase spending.
It requires a different mindset.
Benefits communication should become part of the employee experience throughout the year rather than being concentrated during open enrollment. Quarterly spotlights on specific benefits, reminders tied to life events, educational campaigns aligned with financial wellbeing initiatives, and practical guidance about how to access available resources all help employees build understanding over time.
More importantly, organizations should view claims insights as a strategic resource.
Claims data can reveal where employees encounter confusion, which benefits generate the most questions, and where educational opportunities exist before life events occur. Those insights help employers strengthen engagement while helping employees gain greater value from benefits they already ...
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