Blog - Healthcare Costs: Insurance Benefits, Value & Premium Pricing

Healthcare Costs: Insurance Benefits, Value & Premium Pricing

Healthcare Costs: Insurance Benefits, Value & Premium Pricing

As consumers become responsible for increasingly larger portions of their health care costs, some are reducing their consumption of medical services in an effort to contain the financial impact. While most consumers are not yet comparison-shopping based on cost, this will likely change with the new ACA regulations.

Choosing a health insurance broker is important when implementing a new health insurance plan for your workforce. Talking with experts who help you choose a plan – best for your company and the organization – is beneficial for small businesses that don’t have in house expertise. Consider these five points when evaluating your own coverage.

1. Independent or Broker Relationship
Know if you’ll be working with an independent broker or one employed by a specific provider. Knowing this affects the health insurance options you available to you. To make an informed decision check out the landscape then decide on what’s most important to you: to get the best pricing on a certain provider’s plans or having the widest range of options available to you.

2. Fees Defined
Insurance brokers charge commissions from the health plan on their transactions. That makes it important to understand how these plans work. Verify any separate premium fees you may be charged.

3. Services Your Company Receives
Have a clear picture of what’s included in the scope of services provided by the prospective broker. For instance: Do they only sell you a plan or help with the rollout? Do they assist during open enrollment and help you define it to your employees?

When choosing a plan, it is helpful to remember that all plans – Bronze, Silver, Gold, and Platinum – cover the same Essential Health Benefits. Your monthly health insurance premium will be higher if you choose a higher level plan (i.e. Gold or Platinum. This higher level will also cost less each time you visit a health care provider or get a prescription filled. Conversely, your monthly premium will be lower if you choose a Bronze or Silver plan, but you will pay more for each doctor visit, prescription or health care service that you use.

Essential Benefits All Insurance Companies Must Offer:

– Ambulatory patient services
– Emergency services
– Hospitalization
– Laboratory services
– Maternity and newborn care
– Mental health and addiction treatment services
– Pediatric Services
– Prescription drugs
– Preventive/wellness services and chronic disease treatment
– Rehabilitation services and devices

These Benefits are the minimum requirements for all health care plans. Many plans will offer services in addition to those listed above, but no plan can offer less coverage.

Plan Value
The four types of plans offered – Bronze, Silver, Gold, and Platinum – are defined by their actuarial value, which is the average percentage of health care expenses that are covered by the plan. As the actuarial value increases, the plan will pay more towards your health care expenses and lower your out-of-pocket costs for things like deductibles, coinsurance, and copayments.

The drawback of plans that cover more health care and out-of-pocket expenses is a higher monthly premium.
Exact percentages will vary by state, but on average a Bronze plan will cover 60% of covered medical expenses and your share will be the remaining 40%. The actuarial value of each plan is seen below:

90% Platinum
80% Gold
70% Silver
60% Bronze

Premium Pricing
Monthly premiums are based on the items below, regardless of which coverage level you choose:

– Age
– Smoker or Non-Smoker
– Current Insurance Company
– Where you live
– People enrolling with you (children / spouse)

4. Assistance You Will Receive
It’s very important to understand that choosing a health care plan is ongoing for you and your employees. Ask the broker what assistance is provided after you’ve rolled out your new plan. Will the agent be available to you throughout the year and do you have a dedicated account manager? Know who the contact is if you or your employees have any questions about coverage, premiums, deductibles during the plan year?

5. Facts About ACA
ACA health insurance is a legal requirement for almost all organizations, and technical compliance failures could cost your company significant penalties. Your broker must understand all of the regulations surrounding the ACA.
Ask your potential health insurance broker these questions and get a clear understanding of what to expect if and when issues arise, you can be confident you’ve chosen a trustworthy agent who will help you find the best-fit insurance plan for your company.

TelePay Insurance Agency offers general liability coverage and expert advice on health plan business services. We offer unique products that other brokerages are unable to because of our partnership with Telepayroll. Visit our websites: www.asuresoftware.com; email: info@asuresoftware.com or call us at 800-977-2976.

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