health insurance industry has changed rapidly
during the managed care revolution. If
and when an employer decides to offer group
health coverage to his employees, deciding
which type of plan to offer as well as
which company to use is no simple task.
- Which is the way
to go HMO, preferred
provider organization (PPO), point of service
- Would my employees
prefer going to their own doctors or would
the physicians available in an HMO be sufficient?
- Which plans to offer
alternative medicine treatment?
- How many people do
I need in order to qualify as a group?
Usually, the deciding factor
in selecting a plan for most business owners
ends up being the bottom line or monthly
expense. But just as important as premium,
there other more important considerations
when selecting a quality health plan for
employees. After all, offering a top flight
health plan can insure the future of a business.
A good health plan can help retain good employees
and aid in attracting prospective employees.
Plan will protect your employees
and their family - a good health
plan can help retain good employees
and aid in attractive prospective
HMO's, PPO's and POS's
have many features in common. But in the
end, each of the more than 1,000 plans now
in existence is distinct in its own way.
Benefits offered and premiums charged may
be similar - but the quality of the provider
selected, responsiveness to patients complaints
and general policies that the plans operate
under may be worlds apart.
Group health plans are categorized as small
(2 to 50 employees) and large (50 and above).
Prior to July 1,1997, the smallest group
allowable was a 3 person
group. When the industry realized it was missing out on a significant number
of new group cases they reduced the minimum size group to 2. This enabled
the growing number of entrepreneurs now working
from home to qualify for group
Previously, point of service plans were
structured so that an insured needed a referral
primary care physician to see a specialist out
Most POS plans now offer Open Access (no Gatekeeper) plans which eliminate
the need for referrals. The only significant difference between gated and
non-gated plans is cost (non-gated plans are
typically 4-5% more than gated plans).
Our agency will continue
to monitor developments in the managed care
revolution and our benefits professionals
invite you to call us about health coverage
that's affordable and fair.