Any employer concerned about providing health care benefits for his or
her employees has to first understand the parts of the benefit plans that
matter most to the employees. In a majority of cases, the two factors employees
care most about are the provider network
and the cost of the plan.
For many employees, trying to weigh
the importance of those two factors is not
always easy. The complexity of health
insurance can make it even more difficult. For instance, how much importance
should an employee place on the network
access he or she would have with a
PPO plan?
“An employer needs to provide employees with an array of choices and education materials to inform employees about
what they can and should expect from a
health plan,” says Anthony Benevento,
vice president of sales and marketing,
UPMC Health Plan. “That is the best way
to provide for their health care needs.”
Smart Business talked with Benevento
about what employers can do to help
employees select a health plan.
What should an employer look for in health
care coverage?
First, the plan options need to be affordable for the participants. Employers
should communicate with employees to
understand what costs they feel they are
able to absorb. Beyond that, you should
look for things such as preventive care
benefits, quality customer service and
extensive online tools and services. You
also need to research a health plan’s reputation. Is it one of quality? Is it reliable?
Has it established a good track record?
But, remember, to an employee, that can
all be secondary to a bigger issue: Does
the health plan’s network of providers
allow them access to the hospitals and
physicians they prefer? Figure out the
employees’ needs, and then look for a
plan that helps meet those needs.
It is also beneficial for an employer to
look at the extras a health plan provides.
For instance, are there wellness programs available for employees? Does the
health plan place special emphasis on preventive services? Are there added benefits, such as discounts at gyms or fitness
clubs? Such added benefits add value to
the overall plan and often help improve
the overall health of employees.
An employer should also be aware of an
insurance company’s reputation in the
region and how well established it is.
How can an employee determine how much
a health benefits package will cost?
To determine the true cost of health
insurance, the employee must look at the
cost of the monthly premium as well as
other costs, such as co-payment requirements for doctor visits and other services, out-of-network costs and co-payments
or deductibles that would be part of the
prescription drug coverage. There are
also less visible costs of which one
should be aware, such as coinsurance,
which is the part of the cost that is owed
by the insurer after the deductible is met.
Also, is there an annual limit to the
amount of money spent or to the number
of hospital days permitted? An employee
needs to look at all these things to determine true cost.
Why is it beneficial that employers provide
quality health benefits for their employees?
Simply put, this is something that is considered extremely important to employees. A 2007 survey sponsored by the Center for State and Local Government Excellence showed that 84 percent of workers
place an extremely high value on health
care coverage. Medical insurance ranked
higher than 14 other benefits and offerings in the survey. In general, health insurance has been shown to be good for increasing retention, improving recruitment
and morale and lowering absenteeism.
Should an employer use a broker to help purchase health insurance?
There is no one correct answer for all
employers. Each employer needs to
make that decision based on factors such
as the size of the company and the comfort level an employer feels with dealing
with health insurance issues. If you do
decide to work with a broker, look for
flexibility, responsiveness, services that
are unique to that broker and the ability
to solve problems. You also want a broker to be able to provide a fair cost analysis of all of the options available to your
organization.
What type of benefit information should an
employer provide for employees?
A summary of benefits is essential
because employees need to know about
their coverage. Details about coverage
limits, such as pre-existing conditions,
should be shared along with coverage for
preventive services, procedures and
medications. Any information about drug
coverage and cost sharing is important to
employees, as is information on nontraditional coverage, such as consumer-directed plans.
ANTHONY BENEVENTO is the vice president of sales and marketing for UPMC Health Plan. Reach him at [email protected] or
(412) 454-7826.