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@example.com or (412) 454-7826.