Q&A: Where do I start? I Need To Find a Company Health Insurance Plan

Q: How Do I look for health insurance plans for our company? We are not sure where to start, with private companies or a broker. 

We suggest learning the basics of Health Plan Shopping first. Below is a quick guide to get you primed.

By planning ahead for your company’s growth—and keeping an eye on your health insurance responsibilities under the ACA—you’ve put yourself in the best possible position.
When it comes to health insurance, you want to meet the needs of your diverse employees—but how can you be sure your health insurance plans match your people?

Lots of factors go into choosing the right health insurance plans. A young, healthy workforce may find less value in comprehensive health insurance compared to an older workforce—and the needs of a single employee are different from a family with dependents. You may need to enlist the help of a benefits advisor. The job of a benefits advisor / broker is to strike a balance between the budget you have and the benefits you want. They do this by reviewing facts about your company and recommending different types of plans.

5 Factors in Benefits Plan Selection

1. Employee Demographics. What are the ages, genders of your employees? Families?
2. Geographic Location. Where are your employees located? Plan rates used to be based on geographic dispersion, but in 2016, they’ll go by employer’s zip code.
3. Budget Constraints. How much variety can you offer within your budget? More than you think!
4. Historical Data. What types of plans have you had? What did your employees think?
5. Strategic Direction. Is the company growing rapidly or scaling down? To attract and retain talent, we advise growing companies to offer more plans and variety.

Common Health Insurance Plans

Preferred Provider Organization (PPO)

• The Gist: Employees have access to a large network of providers at a reduced rate. Employees can seek care with out-of-network providers for an additional cost.
• Best For: Families with children and single employees who prefer to research and choose their own providers
• Employer Contribution: Employers usually cover 50-60% of their employees’ premiums and 25-40% of any dependents’ premiums.

Health Maintenance Organization (HMO)

• The Gist: Employees coordinate all care through a primary care physician. With the exception of emergency services, all visits to other providers require a referral.
• Best For: Employees who like a one-stop-shop for preventative care, pharmacy, and specialists—all in one location
• Employer Contribution: Employers usually cover 50-70% of their employees’ premiums and do not cover dependents. If a base plan is established, then the employee is responsible for any remaining premium above the base amount.

High Deductible Health Plan with Health Savings Account (HDHP with HSA)

• The Gist: Employees pay less in monthly premiums, but must pay more out of pocket for healthcare services before insurance coverage kicks in.
• Best For: Young, healthy employees who don’t use healthcare benefits much, but want the security of a health insurance plan in case of major calamities.
• Employer Contribution: Employers usually make this the “base” plan for contributions by paying 80-100% of their employees’ premiums and little, if any, dependent premiums.

Health Insurance Plans

Here are a few types of common insurance plans and their factors.

• A $1500 PPO on a National Provider Network. This plan is suited for employees with routine medical care needs—particularly families with kids. It also offers a much broader network approach for those employees who want a greater choice of providers.
• An HMO with $0 or minimum deductible. This plan is suited for employees who have ongoing regular medical needs for specific health issues. Having great access to specialists and facilities is a huge positive.
• A $3000 Bronze HSA Plan. This plan is suited for young, healthy people—or anyone who doesn’t need regular care. HSAs are also an excellent savings vehicle for employees of any age.

Open Enrollment

Open Enrollment comes once a year, and your benefits advisor can help you adjust your health insurance plans to meet your changing needs. Beyond being a great detective and making people happy, a good benefits advisor also keeps up with the latest laws. Just a couple years ago, it was common for health insurance plans to exclude pre-existing conditions. The ACA made those exclusions a thing of the past—a big win for your diverse workforce.