Planning for Group Health Insurance
When you select a group health plan, there are many factors to consider: Staff demographics, cost, benefits, flexibility, convenience...Most importantly, you will want to select a plan that your staff will use, not complain about.
ASSESSING YOUR EMPLOYEE’S NEEDS: In order to know what type of health plan will be most beneficial to your staff, you might conduct a survey or hold a meeting to gather input — what % of your staff need coverage? Are they willing to contribute to their benefits? If your employees are unfamiliar with the types of health insurance available, a little education about the difference between HMO’s and PPO’s might be useful:
Preferred Provider Organizations (PPOs)
A Preferred Provider Organization (PPO) provides a list of contracted "preferred" providers from which to choose. You receive the highest monetary benefit when you limit your health care services to those providers on the list. If you go to a doctor or hospital that is not on the preferred provider list referred to as going "out-of-network", then the plan covers a smaller percentage of your health care expenses or may cover none of your health care expenses based on the contract wording of the plan. Always check with your PPO or consult your list of preferred providers before you seek health care services to make certain your physician or hospital is a contracting provider (part of the network). Make sure that your doctor refers you to health care providers within your PPO network, if applicable.
Health Maintenance Organizations (HMOs or Managed Care)
Membership in a Health Maintenance Organization (HMO) requires plan members to obtain their health care services from doctors and hospitals affiliated with the HMO. It is common practice in HMOs for the plan member to choose a primary care physician who treats and directs health care decisions and who coordinates referrals to specialties within the HMO network. The doctors and hospital personnel may be employees of the HMO or contracted providers. Since HMOs operate in restricted geographic regions, this may limit coverage for plan members if medical treatment is obtained outside the HMO network or coverage area. California HMOs are required to cover medically necessary emergency services even when outside of their coverage area. The intent of managed care products is to create less costly delivery of health care services while maintaining quality health care by specifying provider choice. HMOs offer access to a comprehensive package of covered health care services in return for a prepaid monthly amount (premium). Most HMOs charge a small copayment depending upon the type of service provided.
FLEXIBILITY: There are dozens of insurance plans within many insurance companies
available to choose from. Do you want to offer the best benefits package
in town? Or maybe you need a low-cost HMO for your staff, but know that
some of your staff prefer extended coverage? Maybe you want the least expensive,
easiest plan to manage across the board…Whatever your goal, you CAN
select the right benefits package for your nonprofit organization.
COST MANAGEMENT: “We can’t afford to provide health insurance” equals “We
don’t mind losing our quality staff.” Since nonprofit salaries
are lower than the corporate average, compensating with health benefits is
critical to attracting and keeping quality staff. There are many flexible
insurance plans to fit the nonprofit budget. Employers need not pay 100%
of the cost of a plan — they can pay as little as 50%! In some cases,
employers can select basic plans, and allow employees to “upgrade” and
pay the difference in cost.
YOUR INSURANCE BROKER’S ROLE: The California Department of Insurance
regulates the sale of health insurance through licensed agents and brokers.
Your broker is YOUR advocate, who understands your programs and your staff
demographics. His job is to research and find the plans designed to meet
your needs, assist you in selecting a plan and guide you through the enrollment
process. You don’t have to venture into “Insuranceland” alone.
Questions? If you have any concerns about your current insurance,
or if you would like information about flexible health plans available to
your organization,
please call us at 714-689-1772.
We have many plans and carriers to choose from…there is no “one
plan fits all” — we’ll
tailor a plan that best suits your needs!
Schweickert & Company
15 Peters Canyon Road
Irvine, CA 92606
Direct Phone/Fax: 714-689-1772
Email: Laura@schweickert.com
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