Employee benefits have never been easy and, considering how vital they are to our lives, they really shouldn’t be. Now, with the influx of AI tools used to collaborate on plan design, implement benefits at workplaces, and supposedly make the whole thing “easier,” it’s actually even more complicated to measure and meet employee needs.
For employers, plan fiduciaries, and benefits committees, the influx of these tools creates both opportunity and responsibility.
AI is shaping employer-sponsored group health plans and the fiduciary obligations for them. Though there are improvements in efficiency and decision making, trust among employers and employees is still paramount – and precarious. Fiduciaries remain fully responsible for ensuring these tools are used prudently, fairly, and in the best interest of plan participants.
We’ve been talking to and reviewing plans and are seeing carriers, TPAs, and service providers using AI to support functions like fraud detection, claims analysis, personalized communications, leave administration, enrollment support, and operational reporting. And there’s a potential upside for sure.
But efficiency is not our only responsibility.
AI adoption requires employers to ask some questions:
- How are AI tools being trained and monitored?
- What data is being used?
- Could algorithms introduce bias or inequitable outcomes?
- What oversight responsibilities remain with the employer?
- How should AI-related risks be addressed in vendor agreements?
These questions are a big deal. AI systems aren’t the same as traditional software. They rely on large language models (LLMs), which generate outputs based on patterns or probabilities. It’s new territory for teams who need to take accountability for benefit plans.
It’s great to talk about AI innovation in healthcare plans, but for benefit leaders, the conversation should include governance, documentation, oversight, and participant impact.
AI will almost certainly become a larger part of employee benefits administration in the years ahead. Employers that begin building thoughtful governance practices now will be better positioned to balance innovation with fiduciary responsibility.
For a deeper look at the evolving legal and fiduciary considerations surrounding AI in health plans, you can read more here.
