Choosing a health plan can be overwhelming and having to choose one for your employers can be even more daunting. Shannon Sims, Director of Sales and Retention with Health Alliance Northwest, provided a presentation this month with 6 steps to consider when choosing a group health plan for your employees.
- Determine your group size
There are two different plan options. The first plan option is Small Group Fully Insured Plans - an employer with 1 to 50 full Full-Time Employees. The second plan option is Large Group Fully Insured Plans - an employer with 50+ employees. Fully insured means the employer pays a set monthly premium, while the insurance pays all the claims. The benefit about fully insured plans is that they have been vetted through the Affordable Care Act, so they all provide the essential benefits needed for preventative health regardless of group size.
When a large group wants to manage their own risk, they have the option of enrolling in a self-insured plan. This means that the group pays for the claims that employees submit. There is not a set premium, instead the group pays a third-party administrator fee known as an AOS fee. If a group is considering a self-insured plan, some carriers offer a balance plan or level funded plan, this allows the group and the plan to share some risk for a year to give the group the experience of self-insured before settling on a decision.
- Choose your coverage option
Shannon calls this part the “plan design”. You can offer employees low or high deductibles depending on the non-preventative services needed. Once the deductible is met, co-payments (set costs) or co-insurance (percentage of overall cost of the care) is collected. Groups should consider out-of-pocket costs too; this is the dollar amount that must be met before the plan begins covering all costs at 100%.
- Consider offering a Health Savings Account (HSA)
These types of plans are designed to be paired with a health savings account; the plans usually come with higher deductibles. Employees who select these plans are healthy and don’t forecast major medical needs for the year. The tax-deductible savings is collected into a Health Savings Account to pay for unforeseen health events. The funds can roll over and don’t need to be used within the year.
- Consider cost-saving wellness programs
Cost-saving wellness programs are designed to reduce the out-of-pocket costs. These programs keep consumers healthy, offers incentives, and overtime reduces chronic conditions and hospital costs.
- Extend coverage to retiree benefits
Many in the valley are retirees that are actively working. Retain employees by offering Medicare group plans. Medicare Advantage Premiums are much lower than commercial premiums. Plus, there’s no separate administration cost for the group and no underwriting for the employee.
- Call on your neighbors
If you have insurance through a carrier, still shop for plans year to year to ensure you’re receiving the best for what you pay for. When working with a broker, ask about the customer experience with the various carriers and even ask for recommendations.
Please refer to the presentation by Shannon Sims on the Chamber YouTube page. You can also visit the OIC website for more resources at https://www.insurance.wa.gov/.
