Choosing a health plan is a big decision for employers of all sizes, both large and small, new and established. And it’s a decision with an intimidating number of nuances and choices.
While you want the best for your employees, there are also costs to consider. Health insurance can be a hefty financial commitment, so it pays to be informed and shop smart.
Whether you’re offering health insurance for the first time as a new business, or deciding if it’s time to switch health plans, here’s what to look for when shopping.
Weighing the costs of employer-sponsored health insurance plans
The cost of your health plan can be greatly impacted by the type of plan you choose. But what do all those acronyms mean for you and your employees? Below we break down the most common health plan options – and spell out those acronyms.
Self-funded health plans vs fully insured
If your health plan is fully insured, that means you buy health insurance from an insurance company. Most small to medium businesses opt for a fully insured plan because it limits the risk to the company and provides the most cost predictability.
If you have a self-funded plan, you create and operate your own health plan, usually with the assistance of a third-party administrator. The financial risks are greater with a self-insured plan, and costs are less predictable than they are with fully insured plans. However, some large organizations choose this approach because it saves money and they are able to tolerate the additional risk.
A third option is level-funded plans, which are self-funded plans that moderate the financial risk and look more like fully insured plans with “premium equivalents”. These plans offer some of the cost savings of a self-funded plan, but with less financial risk, combining the best of both worlds.
Network size and structure
Your plan’s network size will impact how many options your employees have in selecting their care and how much they pay out of pocket.
Some plans offer a narrower network of “preferred” providers – doctors, hospitals and specialty care. Members get the most coverage and pay less out of pocket when they see preferred providers. They can still choose out-of-network providers, but may have limited coverage and pay more out of pocket.
Other plans offer a broader network of providers (sometimes called “open access” networks). Members have the freedom to choose from more doctors and hospitals, but they must designate a primary care doctor. Their out-of-pocket costs are higher for specialty and out-of-network care unless they get a referral from their primary doctor.
Plans with HSA, FSA and HRA options
Health savings accounts (HSAs) and flexible spending accounts (FSAs) are not insurance plans but rather tax-advantaged savings accounts that help employees pay for health care expenses. Both HSAs and FSAs allow employees to set aside pretax money from their paychecks to cover eligible medical expenses. HSAs are used with high-deductible plans, and funds roll over from year to year. With FSAs, the funds must typically be spent each plan year, or they will be lost. Look for plans with both FSA and HSA options to provide the most flexibility for your employees.
Health reimbursement arrangements (HRAs) are an employer-funded health plan. Employees submit out-of-pocket medical expenses such as copays, deductibles and coinsurance to their employer’s HRA for tax-free reimbursement.
Questions to ask a broker when choosing a group health insurance plan
Cost is often the top factor that employers look at first, and understandably so. But as cliché as it might sound, it’s important that you don’t sacrifice quality for cost. Instead of just going with what seems to be the cheapest plan, consider overall value. What are you getting for the cost you pay?
Here are some questions to help uncover the value of health plan options.
Does the plan help your employees get the care they need, when and where they need it?
If employees are sick, will they need to go into a clinic for an appointment? Or, does the plan offer lower-cost services like Virtuwell or Doctor On Demand, which allow them to receive care online or by phone, without an appointment? Does the plan have a 24/7 nurse careline to answer questions day and night? These services are not only more convenient for your employees, they also keep costs of treatment down.
At HealthPartners, we’re dedicated to keeping costs manageable without sacrificing quality of care. In addition to Virtuwell, Doctor On Demand and a 24/7 nurse CareLine, our telehealth services make it convenient for members to get the care they need from the comfort of their homes.
How will the plan keep my employees healthy?
A good health plan isn’t just about treating illness, it’s also about promoting health and well-being. And keeping your employees healthy is good for business. Healthy employees take fewer sick days and are more productive when they’re at work.
To that end, choose a plan that offers free employee health assessments, plus tools and resources to keep employees healthy and engaged. At HealthPartners, we offer all of this and more.
Are integrated benefits an option?
Does the same company offer commercial plans for medical, dental and pharmacy? This “integrated” approach provides significant advantages, including cost savings, convenience, and simplified administration and reporting. And for your employees, combined benefits can drive a more positive patient experience and better health outcomes. Integrated plans are a major advantage of our offerings at HealthPartners – you can get pharmacy, medical and dental benefits from a one-stop shop.
What kind of pharmacy benefits does the plan offer?
Pharmacy benefits are a big topic. Be aware that hidden costs like “spread pricing” can impact the overall cost of your plan. Understanding how prescription drug markups affect pharmacy benefits can help you determine if the drug rebates are actually saving you money or just making things more complicated. At HealthPartners, we deliver a cost-effective approach to pharmacy benefits, focusing on integrity and transparency to provide you with the greatest value at the lowest net cost.
What do your employees want in group health insurance?
It’s important to consider your employees’ needs and wants when shopping for employer-sponsored health plans. A strong benefits package can attract more sought-after employees and improve retention. Health insurance has always been a priority, but now people are looking for their health plan to be something more than an insurance card that they use when getting checkups.
Here are some of the top insurance plan features that employees want:
A plan that fits their budget and lifestyle
When choosing a health plan, employees are just as concerned about cost as employers. They want to know things like: Will this health insurance plan help me save money if I’m healthy?
Will this health insurance plan be affordable if I’m sick? How much will my prescriptions cost? How much will it cost to include my family?
Simply put, employees want to be able to choose a plan that fits their budget and lifestyle – and that’s not going to be the same for everyone.
The cost of an employee’s health care can be dramatically affected by the health plan they have. Things like copays, coinsurance and deductibles add up, especially with chronic medical conditions. On the other hand, if an employee visits the doctor only once a year, the last thing they want is a high monthly premium.
With HealthPartners, you can offer employees a broad range of options – including high-deductible HSA plans and low-deductible plans with FSAs. That way, everyone has an option that makes sense for them.
Support that makes it easy to get and manage health care
It shouldn’t be tough for your employees to get the answers they need, so we’re here for them – when and where they need us.
Our tools for web and mobile simplify the process of getting health care and managing the costs. Members can access information online or through an app, find care and coverage, and check their deductible and balance on their FSA or HSA.
And if members have questions, personal support is only a phone call away. We’ll explain plan benefits and claims, or help them find a doctor. We are proud to offer award-winning 5-star customer service.
A broad network for primary and specialty care
Your employees want to be able to choose from a wide range of providers, both for primary care and specialty care. HealthPartners is nationally recognized for delivering excellent health care through a network with over 1 million providers and more than 6,000 hospitals.
In Minnesota and western Wisconsin, we have an extensive family of HealthPartners clinics, hospitals and specialty care centers. And in other regions, we partner with trusted local providers such as UnityPoint Health in Iowa, and Bellin Health and ThedaCare in northeast and central Wisconsin (through Robin with HealthPartners).
By choosing a HealthPartners plan, your employees will have their choice of doctors and locations for their routine and specialty care.
Discounts and perks for a healthy lifestyle
Your employees may wonder what a health plan can do for them if they are already healthy. We believe the answer is to make it easier and less expensive to stay healthy.
HealthPartners plans come with valuable employee perks such as discounts on fitness programs and equipment.
Help with the tough stuff
When life throws us curveballs, the last thing we need is more hurdles to overcome when getting help. HealthPartners makes it easy for members to find the resources, guidance and care they need, no matter what life throws at them. We are known for our nurse CareLine that is available 24/7 to help members understand their symptoms and treatment options. But that’s just for starters.
HealthPartners is committed to supporting your employees wherever they’re at with health – and life. We’re committed to being a resource during times of stress and times of change. We have counselors available day and night to help employees with marital issues, grief, mental health, pregnancy, parenting and more.
Put simply, we’re there for your employees when they need us.
Peace of mind
While your employees consider a lot of factors in choosing health insurance, what they ultimately want is quality care and coverage. They want to know that their family can get the care they need, when and where they need it. You can’t put a price tag on peace of mind, and with HealthPartners, your employees don’t have to.
How to buy employer-sponsored health insurance – considerations and next steps
If you’re ready to get started, talking to a health insurance broker would be a great next step. Brokers can walk you through various insurance plan options to help you find the best fit for you and your employees.
Brokers do the busy work for you – getting quotes for different health plans and helping to enroll employees, or reviewing your current contracts. They’ll even help you understand the benefits and limitations of each health plan option. Best of all, you won’t pay anything additional for all their insights and support.
As you work through your options with a broker, please consider HealthPartners solutions. We offer a range of regional health plans in Minnesota, Wisconsin, Iowa, North Dakota and South Dakota– and in many of those regions, we work with trusted local care partners to deliver top-notch care and coverage.