How to Make Sure You’re Receiving Proper Employee Health Benefits Insurance
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How to Make Sure You’re
Receiving Proper Employee Health Benefits Insurance
Many small businesses may meet or exceed
the threshold that makes it necessary for them to offer their employees health
insurance plans and other benefits.
Given the rising
trend of remote work, hybrid workplaces, and the availability of affordable
part-time and full-time employees, more business owners have started examining
their options regarding health insurance plans.
Not all employees are well-versed in
what to look for in employer-sponsored healthcare plans. Just because employers
may support part of the cost doesn’t make all plans equal. Sometimes you can
still be better off not choosing a plan provided by your company or
organization.
It all comes down to weighing the
benefits, understanding the cost breakdown, and looking at various other
factors before deciding. The right plan can give you better coverage and
savings, while the wrong one can cost you more money down the line.
Look at the Cost Not all employee health benefits
insurance is created equal. Some plans benefit employees more than others, and
the differences are often reflected in the price. If you’re working for a
reputable employer, chances are you have already received numerous documents
outlining the costs of the health care plan. Looking closely at the numbers and
understanding them is essential. You must know the coinsurance costs, copays,
premiums, out-of-pocket maximums, and potential deductibles outlined in the
insurance papers. Another aspect worth checking is whether
the insurance is offered to individual employees or if it’s part of a group
health care plan. Group insurance is cheaper because carriers charge lower
premiums and employees can share the cost.
Understanding the Numbers
There are three key figures needed when comparing
employee health benefits insurance plans. ·Premiums
are the monthly amounts charged by insurance providers that you can split with
the employer. ·Deductibles
refer to how much employees must spend for their insurance coverage to activate
insurance coverage or reimbursements. These figures reset yearly and can range
from hundreds to thousands of dollars. ·Copays
aren’t always deductible. These are charges the employee may have to make in
addition to the monthly premiums when visiting a doctor.
Make no mistake.
Premiums are an essential consideration, and employees earning minimum wage
often value discounts more than anything else. But sometimes, the coverage is
more important.
To determine what
matters most to you, try to figure out your annual healthcare costs. If you
have a disability or chronic condition, you may need lower deductibles, even if
it means paying higher premiums.
You may want lower
deductibles and better coverage if you plan to start a family, need surgery,
buy expensive medication, or expect to incur more medical expenses in general.
Alternatively, you could opt for low premium plans and higher deductibles if
you don’t think you’ll need much medical care.
Check
the Network
Usually, employee health benefits
insurance utilizes health maintenance organizations (HMO) or preferred provider
organization (PPO) plans. Understanding these two options is key to ensuring
you get proper benefits or the best personalized employer-sponsored insurance.
Ideally, you want an insurance plan
covered by a broad network of providers. PPOs, or preferred provider plans, may
have well-defined networks of hospitals, doctors, and clinics. However,
employees can also occasionally go outside said network and still use their
employer insurance. This isn’t possible with HMO plans, which are known for
their inflexibility.
But not everyone wants flexibility. Some
employees may need to continue seeing physicians and specialists in a
particular network. It helps people suffering from chronic illness or those
with a long patient history. If you want to keep seeing the same
doctors, you must ensure that the employee benefits insurance plan’s network
overlaps with your doctors. Doctors outside the network will still see you, but
you may have to pay a lot more for consultations and treatments.
Alternatives to PPOs and HMOs
There are two more types of health
insurance employees can sometimes get courtesy of their employers. An exclusive
provider organization (EPO) plan means that the insurance may pay or reimburse
for select services carried out by specific providers.
Another plan you may run into is the
point of service (POS) plan. This one shares similarities with HMO plans, like
requiring a referral to benefit from certain services. Some POS plans may still
pay for out-of-network services, which isn’t an option with HMOs.
See if the Plan Is Qualified
Not every employer must provide
employees with benefits and health insurance plans. Businesses with 50 or more
full-time employees must present qualified health plan options to their
employees to avoid financial penalties.
But that doesn’t mean all plans are
considered qualified. According to the Affordable Care Act, a qualified plan
must meet specific criteria and cover 10 specific benefits.
·Prescription
drug benefits ·Pediatric
care ·Emergency
treatments and emergency room visits ·Outpatient
care ·Inpatient
care ·Health
coverage during maternity and for newborns ·Substance
abuse and various mental health treatments ·Recovery
and rehabilitation services ·Laboratory
services ·Health
screening, vaccination, and other wellness or preventive services
Get the Plan That’s Right for
You
Every employee may have unique health
insurance needs and expectations. That’s why rushing to commit to a plan is
seldom a good idea. People with unique medical conditions, work arrangements,
or specific family situations must do their due diligence before making such a
critical decision regarding their healthcare options and finances.
Luckily, it’s easier to compare plans
once you understand how to break down the cost and what benefits matter more
than others in certain situations. And if you’re lucky to have a great
employer, you may have multiple options to choose from or even the perk of
customizing your own health insurance plan.
