Better health plans

Selecting the proper health benefit
plan can be crucial to any employer
as it is both a major financial investment and contributes to a healthy and productive staff. While selecting the basic plan
is the first step, employers cannot stop
there. It is then important to ask what features or wellness programs can be added
to create the most valuable plan possible at
the best cost.

Programs such as HealthbyChoice
Incentives can help employers save up to
13 percent on premiums depending on the
plans they offer, says Don Whitford, director of sales and client services for Priority
Health. Such programs are designed to
encourage healthy lifestyles for employees.

In part two of the health plan series,
Smart Business spoke with Whitford
about the success of combining health and
wellness plans and how they can save
employers money.

What is HealthbyChoice Incentives?

It is a health plan combined with a wellness program that looks at employee
behaviors. There are two different benefit
designs in this plan: choice and standard.
With this plan, qualifications are developed
that an employee must meet. If the employee meets the qualifications, he or she is
placed in the choice benefit design group
and his or her deductibles and co-pays are
lowered. If an employee doesn’t meet program requirements, he or she is placed in
the standard design plan and has higher co-pays and deductibles.

How does an employee begin the process of
HealthbyChoice?

Employees begin by completing a health
risk assessment within 90 days of the commencement of the plan. Their physician
must fill out a qualification form supplied
by the health plan. This form requires the
physician to evaluate and confirm that the
employee is a non-tobacco user, has a body
mass index under 30 and his or her blood
pressure is under 140 over 90.

Employees who meet these qualifications
are moved to the choice category and are rewarded with lower co-pays and
deductibles. If the employee does not meet
these qualifications, he or she is not limited
to higher co-pays and deductibles. Rather
the employee can complete a fasting cholesterol test, a fast blood sugar test and
agree to follow a treatment plan designed
by his or her physician and still be rewarded with lower co-pays and deductibles.
Employees who do not meet qualifications
and choose not to follow a physician’s plan
will have a health plan with higher costs.

The HealthbyChoice plan is a participation-based wellness program, not an outcome-based program. Therefore, you will
not be required to drop 40 pounds
overnight, rather you are asked to follow
the plan your physician has designed to
help you live a healthier life.

How does the difference in co-pays and
deductibles affect an employer?

An employer’s rate remains the same no
matter the benefit design in which employees are placed. There is still a savings if all
employees move into the choice design
program. Employees in the choice program are leading healthier lifestyles, therefore requiring less medical care and reducing overall medical costs. It is important for
employers to communicate to employees
that participation is rewarding, both financially and in life.

Why would an employer want to introduce
the HealthbyChoice Incentives plan?

The goal of this plan is to get employees
to emulate healthier behaviors and live a
healthier life. By doing so, the employer
and the employee experience cost savings.

In addition to premium savings of up to
13 percent, HealthbyChoice Incentives is
beneficial to the employer because the
health plan will evaluate the data collected
and provide a comprehensive study for the
employer to review and utilize when deciding what plans and coverage to select in the
future. The health plan will also help the
employer implement programs to improve
on areas of employees’ weaknesses detected in the study.

Are there other plans that can help reduce
employer costs?

Other programs, such as co-payment
alignment, set different prices for different
services. For example, a co-pay for a visit
to a general physician may be $10, a specialist $20 and the emergency room $100.
The point of this program is not to discourage the use of medical facilities but rather
encourage people to seek care in the most
appropriate setting. It helps discourage
people from using emergency rooms for
everyday needs.

This concept can be applied by itself or
with any other benefit design plan excluding the Health Savings Account. It can save
up to 6 percent on premiums alone. It
encourages members to see a general
physician for a cold or cough to receive
the same quality of care but at a fraction of
the cost.

DON WHITFORD is director of sales and client services for Priority Health. Reach him at [email protected] or
(248) 324-2711.