Health plan tips Featured

11:52am EDT July 31, 2002
Determining which health plan is best for employees and your small business can be challenging. The options can confuse and overwhelm even the best human resources professional.

However, understanding a few key concepts can help ease the search for health insurance and ensure you get the most value from your premium dollars.

* Know your employees' needs and wants.

Determining your employees' health care needs is a fundamental first step. For example, is your work force comprised primarily of women? If so, you need a plan with an extensive list of physicians who care for women, and make sure the insurance company includes coverage at in-network rates for the leading women's care hospitals.

The scope and quality of the insurer's doctor and hospital network is critical in maintaining employees' long-term satisfaction. Make sure quality hospitals and physicians are nearby. Some insurers, for example, won't cover care at the most advanced hospitals. Or they reduce the amount of coverage when employees use the best facilities.

* Seek the help of experienced professionals.

Many employers go it alone when sorting out the details behind health care. However, health care brokers can offer experienced guidance.

Brokers are licensed sales representatives who usually represent several insurance companies. Most do not charge you for their services because the insurance companies pay them commission on the premium revenue they generate.

* Understand what you're buying.

Health care plans generally fall into one of these categories: Health maintenance organizations (HMOs) provide coverage through a network of doctors who agree to contractual payment terms. Costs are held in check by these agreements, and members usually pay small co-payments when they visit their primary care physician.

Point-of-service plans (POSs) function much like HMOs, but allow members to seek services outside the network of contracted physicians, which usually involve a higher out-of-pocket costs.

Preferred Provider Organizations (PPOs) have fewer rules but still provide very good coverage. Benefits are usually reduced if employees use nonnetwork doctors or hospitals. Members direct their own care. Rick Teaff is a senior writer at UPMC Health Plan.