How do you compare health insurance plans in employee benefits packages?

In my experience, business owners shouldn't only use a spreadsheet to compare their health benefit plans. Excel spreadsheets can't demonstrate the innovative, unbundled, actively managed, employer built health plan ideas that can be implemented to provide a better healthcare experience for the employee for less money.

The only thing in Health care plans: How are you going to lower the frequency and severity of claims? The budget should not be focused on Annual premium, it should be focused on medical claims. If you looked back the last 5 years, what's the trend of annual premium increase? Before an employer can budget, they need to have a plan. Focus on cost containment strategies on the claims and the premiums will take care of themselves. The strategies will show the posibilites for your goals.

In the small employer market, where plans are canned, and designed by the insurers, there is not much room for comparative analysis. Most employers like to stay close to where they are on benefit levels; either when changing plans, or renewing the current insurer. In the larger spaces, Mid-to-Large 51 - 500+, there are more options. Plans can be designed around the objectives, cost containment, and a longer term strategy. I've found that a good comparative date requires a deeper dive into employer and employee expectations. The key for employers is to own their own claims data, and uncover where the claims dollars are going.

It's essential for a firm to first clarify its objectives with its benefits strategy. An important start is by analysing the firm's demographics to determine which benefit approaches are most aligned with the needs and preferences of its employees. Additionally, it's important to assess the various health risks that could affect the employees and the firm. This includes considering external factors, such as region-specific health risks (for example, the prevalence of cardiovascular issues in the APAC region). Understanding these external elements is crucial for the firm to tailor its benefits strategy effectively to the broader environmental context from which it operates.

I’ve found the most successful employers at controlling their healthcare spend are progressive and forward thinking in their approach. They work with an advisor who challenges both the customer and status quo. They ask questions and listen to the factors that influence health care costs and devote time and effort into mitigating these factors as this results in lower health insurance costs.

If you are seeing best value, then HMO is your goto, and the optimum insurance company is Kaiser (I dont work for Kasier) If a company is in tech, then not offering a PPO will place you as an outlier. Please stay away from EPO: everyone runs to those for the savings and then is shocked to know there is no out of network coverage

Navigating health insurance plan types—HMOs, PPOs, EPOs, HDHPs—is crucial for tailoring benefits to your organization's needs. Each plan type offers different network choices, costs, and coverage details, including deductibles and copays. Leveraging our expertise in financial data analysis, we guide you in understanding these factors to ensure your employees have adequate access to quality care while aligning with your financial strategies. This precision enables informed decision-making. #HealthInsurance #EmployeeBenefits #HRManagement #StrategicPlanning

HDHP's with HSA's have gained popularity due to cost-sharing benefits. HMO's and PPO's remain common, offering different networks and coverage structures. EPO's are sometimes chosen for a balance between cost and flexibility. The trend is toward providing choices to meet employees' preferences and healthcare requirements.

Actuarial modeling elevates health plan selection, balancing costs and quality across HMOs, PPOs, EPOs, HDHPs. It navigates deductibles, copays, ensuring plans meet financial and healthcare goals. This strategic alignment optimizes benefits for cost-effectiveness and comprehensive coverage, enhancing employee satisfaction. A forward-thinking approach to benefits design positions companies as top employers by prioritizing workforce well-being and financial stability. #HealthcareStrategy #EmployeeBenefits #ActuarialModeling

Depending on your state/location, there could be various different types of health plans out there for you. Going with an HMO/EPO type health plan will narrow down health plan providers, but could create huge cost savings. Do an employee provider survey to see what providers people use the most and cut out the providers no one uses to save money! The more providers you have in network, the most expensive your plan will be!

Employees struggle with choosing the most cost effective health insurance plan? HR inundated with questions about the health plan offerings during open enrollment? Employers looking for ways to reduce health care costs? HEALTH PLAN CALCULATOR crunches the numbers on an after-tax advantage basis, showing a side-by-side comparison of the REAL costs of the various plans. Employees save time, money, and get peace of mind that they are making the most cost-conscious choice. HR isn't so besieged with questions during open enrollment. Employees making more cost-conscious decisions save the Employer money in matched health care costs. Employers get good will by offering this value-adding tool to their Employees. Aids in Employee retention.

Open enrollment data shows that 74% of employees said choosing a health plan is confusing. This lack of understanding and confusion leads 86% of employees to stay with their existing health plan or make no changes year over year during open enrollment. In my experience, most employees get frustrated and make their choice on the lowest per pay period cost plan regardless of plan design or their health utilization or needs. You can consider investing in decision support tools that guide employees through a decision matrix, recommending the best plan for their needs. You'll find that the investment in these programs will lead to higher employee satisfaction with their benefits offering and less noise for HR.

In health insurance plans, the employer usually always pays the claims themselves. Even in insured plans, because when the claims increase, the premiums + risk premiums also increase. The employer must therefore try to get the claims under control. This is the only way to secure or reduce premiums in the future.

We found that evaluating the total costs, including premiums, deductibles, co-pays, and out-of-pocket maximums help. However, don’t focus solely on premiums. Consider the value - what services are covered, the quality of the provider network, and additional benefits like mental health services or telemedicine. Sometimes a plan with a higher premium might offer better value through lower out-of-pocket costs or better coverage.

Effective benefits management involves more than just comparing premiums. Assess the total cost of health insurance plans by considering deductibles, copays, and out-of-pocket expenses against your employees' health needs and utilization. Also, evaluate the plan's value—benefits relative to costs. A higher value plan offers more coverage and benefits for a lower cost, optimizing your investment in employee health. #EmployeeBenefits #HealthcareCosts #HRStrategy #ValueBasedCare

It’s important to balance employee feedback with sessions to educate and learn about best stewardship for your accessing benefits. Lunch and learn sessions, webinars, open house and health fair events can help create understanding within your plan. Greater value is often aligned with better understanding.

Getting feedback from employees is so vital in a healthcare plan. You could have the best and most unique benefits if your employees do not know, they cannot use them. Actively seeking to understand what it looks like from their point of view is such a big help. Sometimes it helps me to remember I live in the world and sometimes do not understand everything. Explaining it and understanding where the employees need more help can only improve the plan.

ALWAYS conduct an employee survey either online or via paper with your people. Get their input! What you might think is a good benefit, your employees might not value. Get their opinion and build around what they value the most. Then take your bucket of money you have allocated for benefits and tweak your benefits offerings to match what your people really want.

In any given year, in general, about 10% of your employee population will Max Out... i.e. they will hit their Deductible, Co-Insurance, etc.. either do to a medical emergency, treatment of disease, or very expensive drugs. About 30%-40% of your employee base will have minimal to no interaction with their health plan, i.e. minor flue, some antibiotics, etc.. The final cohorts of employees will experience out of pockets in the range of $1,000 to $2,000. I offer this info to give context as to the extreme wide range of feedback clients receive. In the same company majority of the employee can rate the plan A to B+ and others an F. Majority of the feedback is based on out of pocket experience

Don't forget Affordability: The plan must meet ACA's affordability requirement, for plan year 2024 that is 8.39% Employer may not charge an employee more than is amount per year in contributions; i.e. if an employee is making $50,000 employer should limit employee contributions to $4,195 per year or $349.58 per month / of course most contributions should be significantly under this figure

Before selecting a health insurance plan, thorough review of the details and contracts is crucial. Ensure compliance with laws like the Affordable Care Act, ERISA, COBRA, and HIPAA. Assess plan performance, ratings, and provider reputation. Also, scrutinize contract terms regarding renewal options, cancellation clauses, and dispute resolution. Diligent analysis helps secure the best plan for your business and workforce. #HealthInsurance #Compliance #EmployeeBenefits #HRManagement #BusinessStrategy

Don't go it alone. Find the right partner in a Broker/Benefits Consultant who will sit down with you and your team for as long as it takes to find out what needs your organization has. Benefits are not a one size fits all solution. There are countless options in carriers, vendors and solutions that you can get creative with to make sure your organizations needs are met and your employees' families get the quality care they need. The right partner will leverage market knowledge and wellness/cost containment strategies to ensure you get the most value.

You have to use data! You have to use all the data it’s involved in the health plan, which includes claims, costs, sites of service, etc. You have to use that data every day to drive decisions. If there’s a question, you use the data to answer the question. if the data doesn’t exist, then you have to know how to answer the question by either getting data or by using data surrogates. Then you need someone who knows how use the data to oversee all aspects of the plan. This will improve the quality of care and lower costs!!

Here are some things we've found that help as well. Wellness Programs: Some plans offer wellness incentives or programs that can be valuable to employees’ health and morale. Network Quality: Assess the quality and accessibility of the provider network. Flexibility and Future Changes: Consider how flexible the plan is to future changes in your organization or employee needs. Legal Compliance: Ensure the plan complies with relevant laws and regulations. Broker or Consultant: Consider engaging a broker or consultant for expert advice and negotiation support.

What is the long term goal for the employer plan in 2-3 years? Brokers often talk about the renewal. “Let’s get the renewal rates down” which is an obvious need. What about the renewals the last 2 years? What are the expected costs for the next two years vs new options? We graph that out for groups so they can create a budget. Often, we see “flat benefit renewals” followed by 20% renewals. We just saw that with a 125 employee group: 2022 +3% Renewal 2023 + 0% 2024 34%. Upon further review the group had very little claims costs. Their current carrier simply decided it was time to level up the revenue in the group. So we fix problems like this- The Other Thing to think about is-What is the long term plan and how best can you plan for it!