What you should ask before picking company healthcare.

3 Questions To Ask Before Picking Your Company's Health Insurance

Posted August 20, 2019 by Justworks in Benefits and Perks
Whether you’re offering health insurance for the first time or preparing to pick new plans again for this year, you’re heading in the right direction for a flourishing business.

As a growing company, choosing the best health insurance plan is important in making sure your employees are well taken care of. The right plan is not just about the price, but also how useful it is for your employees.

Before determining the right health insurance for your employees, thinking about these three questions could help you make the best decision for your team.

1. How Much Does the Plan Cost?

The biggest concern around choosing health insurance plans tends to be the cost, both for employees and for your business. Your company can go with a low-deductible, high-premium plan, which ensures that out-of-pocket costs are low. These high premium plans may be expensive upfront for either the employee or the company, depending on how much the company chooses to contribute toward premium. You can also go with high-deductible, low-premium plan, which ensures that the upfront premiums costs are much lower.

Your company demographics may influence which option is better. For example, younger demographic may be willing to pay higher deductibles because they don’t go to the doctor often. On the other hand, if your company's age bracket is older,employees will want as much covered as possible.

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When evaluating different plans, look for the four “metal tiers” that offer guidance on how much the health insurance covers.

  • Bronze: 60% Covered; 40% deductible
  • Silver: 70% Covered; 30% deductible
  • Gold: 80% Covered; 20% deductible
  • Platinum: 90% Covered; 10% deductible

Alternatively, some insurance companies use the following format:

  • No Deductible: The premium covers everything
  • Low Deductible: The premium covers a significant amount with some employee out-of-pocket expense
  • High Deductible: The premium only covers a small amount with a significant amount of employee out-of-pocket expense.

However, insurance costs aren’t only measured by how much the premium is. You also need to look at the total deductible and the out-of-pocket limit. The total plan costs equals the premium plus the deductible. So while a plan might seem really cheap from a premium perspective, if the total deductible is factored, it may be better for your employees to have access to other options.

There’s also the out-of-pocket limit. Before the ACA, this was a much more important number to keep track of. However, with current health insurance regulation, the maximum out-of-pocket limit for an individual in 2019 is $7,900 and $15,800 for a family.

2. What Does The Plan Cover?

Cost is an important aspect of the health insurance plan, but it’s not the only thing that matters. Also track what the insurance covers, because the more services your employees can have access to, the more it will cost.

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Most plans will cover the following, at the minimum:

  • Outpatient care: Treatment without being admitted to the hospital
  • Emergency room visits
  • Inpatient care: Treatment you get in the hospital
  • Pre- and post-natal care
  • Mental health and substance use disorder services
  • Prescription drugs
  • Treatments for chronic conditions
  • Lab tests
  • Preventative services, such as vaccines
  • Pediatric services

Dig in to see how much health insurance your employees can access on different plans. Keep in mind there could be caps and rules in place to prevent too much use of certain services.

3. What About Networks of Doctors?

Before selecting a plan, always look at the network of doctors. Health Maintenance Organizations (HMOs) require employees to only visit approved doctors and often times require employees to get approval to see another doctor. These tend to be cheaper than the Preferred Provider Organization (PPO), for example, which lets employees choose their own doctor. Many insurance plans will cover out-of-network doctor’s visits, but these visits are typically more expensive because the carriers don’t have arrangements with the doctor.

Again, consider the demographics and geography of your team. You’ll likely consider different plans if all your employees work in one office than you would if you employ a remote team spread throughout different cities or states.

Pick Insurance Through Justworks

Justworks helps growing businesses provide access to quality health insurance at affordable rates. Your employees will have access to a variety of insurance plans including no deductible, low deductible, or high deductible. You can learn more about us here.

This material has been prepared for informational purposes only, and is not intended to provide, and should not be relied on for, legal or tax advice. If you have any legal or tax questions regarding this content or related issues, then you should consult with your professional legal or tax advisor.