Q1 benefits triage: a calmer February starts here

By January 29, you have already lived the emotional arc.

Open Enrollment ended. Everyone exhaled. Then the first paychecks hit, the “where’s my ID card?” messages started, and somebody forwarded a medical bill with the subject line: “Is this real???”

If Q1 feels brutal, it’s not you.

It’s that benefits get loud when real life comes back online and the system asks employees to interpret a maze at the exact moment they’re least interested in becoming experts.

Also, the stakes are high.

• Annual premiums for employer sponsored family coverage averaged $26,993 in 2025, and workers contributed $6,850 on average, so employees notice every deduction change.
• A Mercer report expects total health benefit costs to increase 6.7% in 2026, pushing the average above $18,500 per employee.
• And a global survey reported by SHRM found 95% of HR leaders and C-suite respondents said “HR is simply too much work.”

So let’s say the quiet part out loud: Q1 is the post-enrollment hangover.

Not because you did anything wrong. Because the year’s most confusion-prone benefits moments are front loaded.

The good news: the pattern is consistent. And when the pattern is consistent, you can design for it.

The three moments that drive most Q1 chaos

We can make this complicated. Or we can be honest about what HR sees every year.

1) The paycheck moment: “Wait, what changed?”

Employees don’t experience benefits as “coverage.” They experience benefits as net pay.

When deductions change, employees assume something is wrong and they ask the fastest path to a human: you.

What helps (keep it simple):

• A one page “why paychecks change” explainer: effective dates, tier changes, per paycheck math
• One intake form that routes payroll issues to payroll with the details they actually need

2) The access moment: ID cards, logins, “I’m at the pharmacy”

This is pure friction. People are trying to do normal things and hit a wall.

What helps:

• One “Get proof of coverage” path that covers digital ID cards, portal access, and “I can’t find it” escalation
• A single rule employees can remember: “If you need proof of coverage today, start here.”

3) The claim and bill moment: “Is this a bill or…?”

This is where Q1 gets emotionally expensive.

People receive paperwork, don’t know what it means, and worry they’re about to pay the wrong thing.

The confusion is real:

• CFPB research notes that 44% of adults reported not paying a medical bill in full (or only partially paying) because they were not sure the bill was accurate.
• CMS is blunt about one of the biggest sources of confusion: an Explanation of Benefits is not a bill.

What helps:

• A plain-language “EOB vs bill” explainer (one paragraph, not a pamphlet)
• A three step “before you pay” checklist
• A clear escalation route so issues don’t bounce between HR, carrier, and provider

Supportive truth: you’re not expected to be a claims expert. Your job is to make sure employees aren’t stuck alone.

The February playbook: 3 moves, not 30

Move 1: Build one front door

Call it “Start here”. Put it where employees already go. Keep it short.

We recommend these five buttons:

• My paycheck changed
• I need my ID card or proof of coverage
• I got a bill or claim I don’t understand
• I need to find care or check coverage
• I need to update a dependent or report a life event

Every button ends in a next step: a link to resources, a number for support, or a form to get more information.

This is the highest leverage thing you can do in February because it turns random inbound into routed inbound.

Move 2: Send two “stop the repeats” messages

Pick the two categories driving the most tickets right now (usually payroll deductions and claims/bills).

Send two short notes:

• “If your paycheck changed, here’s what to check first.”
• “If you got a bill, here’s what to do before you pay.”

You do not need to cover every scenario here, only the most common ones you get questions about.

Move 3: Tighten escalation rules

Write internal routing rules that end ping-pong:

• Payroll deduction disputes go to payroll first with required details
• Billing issues follow the checklist before escalation
• “Proof of coverage” has one owner and one path

Copy and paste: two lines that calm the room

For bills and claims
“An Explanation of Benefits (EOB) is not a bill. If you received a bill, match it to your EOB before you pay.”

For paycheck changes
“Most paycheck changes come from effective dates, coverage tier changes, or per-paycheck math. If it still looks wrong after those checks, submit it here so payroll can review it with the right details.”