10 questions your employees should ask about health insurance
April 30, 2014 5:32 PM
1. Do I get to choose my plan, or does my employer get to choose for me?
Whats happening now is employers are becoming aware of the fact that one carrier is not enough, says Bryce Williams, a managing director at Towers Watson. Youve got to offer choice whether its in defined benefit or defined contribution and thats why you are seeing the proliferation of private exchanges.
[Images: Shutterstock].
[Images: Shutterstock].
2. Do I have a defined benefit, or a defined contribution plan?
Though the system is simple to explain if you're a pro, front-line employees may not understand the basics - are their benefits paid and administered for them in an old-fashioned, easy-to-understand way, or are they responsible for managing their own health care expenditures, possibly through an HSA account?
3. Is there a monthly premium? If so, how much?
Employees who have been only partially paying attention to the noise surrounding the ACA debate may expect rock-bottom premiums, and may be surprised to find out that costs are higher than anticipated.
4. What is the policy's annual individual (or family) out-of-pocket expense limit?
High-deductible health plans are a new move for many employers (and employees) and necessitate more financial resolve on the part of participants. Making the numbers clear - and using the resources of an HSA or other health savings account - can lighten the burden. Knowing the amount you and your family will be required to pay on your own is also critical.
5. Is my current doctor or hospital part of the plan's provider network?
Your family doctor may (or may not) be part of the system offered by a new insurance plan; you may still be able to access his or her services through an out-of-network arrangement, but new insurance may also feed the need to find a new doctor.
6. Is there a deductible? Does a deductible apply to prescription drugs?
Many plans require patients to pay a significant sum of their own money up front before the insurance begins to cover at a high percentage. These numbers are critical, as is knowing whether or not the cost of prescription drugs is factored into the number.
7. Do I need additional coverage, such as dental, vision or prescription drug coverage?
Though some employees see dental and vision as frivolous extras they can find more easily by searching the internet, as voluntary add-ons to their basic medical insurance, they can save money and ensure easier access. Not to mention providing basic diagnostic testing which can help spot more significant health conditions.
8. Are you getting connected with someone who can help you manage your existing health conditions?
Pre-existing diseases and health issues can cause a litany of other side-effects and lead to challenging drug interactions. Getting a coordinated strategy on treatment is critical.
9. How does the plan handle visits to the emergency room?
Too many folks, especially those without a regular family physician, see the emergency room as their primary medical point of contact. But with simple ER visits billing in the thousands of dollars, participants need to know that the ER should be used for emergencies only. At the same time, make sure that ER visits are indeed part of your plan, as they can be critical in a time of need.
10. Are hospitalization and major medical expenses covered?
Should the unthinkable occur, it's also good to know that a hospitalization or an extended treatment for a major condition will indeed be covered by your insurance, and to what extent. Ask plenty of questions about those coverage, limits and exclusions.
