Choosing a health plan can be stressful. Your employees want to make sure they get quality coverage from the doctors they know and trust. They also want to make sure their monthly payments and the costs of the services they need will work for their budget. Our guide to choosing a health plan can help your employees clarify what’s most important to them in a health plan, and what options they have for meeting those criteria.
Step 1 : Understand the most common health care terms
When comparing plans, your employees will encounter a variety of health insurance terminology that can be confusing and overwhelming. It’s important to educate them on the most common terms—like “HMO,” “deductible,” and “copayment”—so they can understand what they comparing.
The complete version of this guide, available for download here, contains a helpful glossary of important health care terms and definitions that your employees should know.
Step 2: Find out if their provider is in the plan’s network
Your employees will want to make sure any plan they are considering will offer the convenient, quality care they and their families need. If they already have a trusted doctor or medical team, they'll want to find out if those providers are in-network. If not, will they be able to access their care? How much will out-of-network services cost? If they aren't able to access that care, they'll need to find out if there are comparable doctors and specialists in the network.
To help determine what type of access your employees need, they should consider the doctors they see today:
- If they already have a primary care provider (PCP) who coordinates their care and refers them to specialists, an HMO (Health Maintenance Organization) plan where they are in-network might be best.
- If they need access to a doctor or hospital that isn’t in-network, a PPO (Preferred Provider Organization) plan may be a better option.
Step 3: Understand premiums vs out-of-pocket costs
It's important for your employees to understand how premiums and out-of-pocket costs like copays and deductibles fit into their budget, and when cost sharing will be expected of them.
Typically, plans with higher premiums have lower out-of-pocket costs and plans with lower premiums have higher out-of-pocket costs. If your employees are comfortable paying more each month to have more controlled costs when they use your health plan for medical or behavioral health services, then a plan with a high premium and lower out-of-pocket costs might be right for them.
If they prefer to pay less each month even though it might cost more when they need care services, they should look for a plan with a low premium and higher out-of-pocket costs.
Step 4: Assess their medical care needs
In addition to monthly budget concerns, your employees should also keep their health care needs in mind when deciding the plan that’s right for them.
- Do they or their covered dependents have an ongoing medical condition that requires regular maintenance medication, such as diabetes, high blood pressure, or arthritis?
- Is anyone in their family planning to have surgery, have a baby, etc.?
How frequently do they access medical care?
If they or their dependents need frequent medical care or anticipate major medical expenses, it may make the most sense for them to look for a health plan with a high monthly premium and a low deductible. If they are in good health and don’t require health care services often, then a lower premium may be the more cost effective option.
Step 5: Review their yearly (and potential) costs
Once your employees know their plan options, they can calculate how much they'll pay each year in premium. Then, they can look at the out-of-pocket costs and note the key differences between the plans they're offered. They can use the Plan Comparison Worksheet included with the employee version of this guide to compare the costs of each of their plan options, helping them make the best choice for the coming plan year.
Helping employees choose a plan
Your employees may need additional help comparing plans, including learning about covered benefits and whether or not a provider is in network. Your Human Resources department or a representative is a great resource to help them find answers to these questions.
You can also direct them to the customer service team of the health plan they are considering. Their staff should be available to answer questions about their options and the plan network.