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A survey by America's Health Insurance an industry trade groupin D.C., found small-group coverage in 2006 averagexd $312 per month for single coveragde and $814 per month for family Helen Darling, president of the National Businessz Group on Health in Washington, D.C., said that when evaluatiny plan options, employers should consider the quality of care provided to its members and not just the premium First on her list is checking to make sure the insuree is accredited by the National Committee for Quality Next would be readinf through the plans' HEDIS (Health Plan Employer Data and Informationb Set) scores, which the NCQA accumulatea to track plans on various performance "You can find out thingw like what percentage of their members receive a beta-blocker after suffering a heart attack," Darling "I'd also make sure the physicians in the plan are, with very few board certified.
And I'd want to see that the plan hasa 'centerw of excellence' program for certain procedures such as organ transplantz and cardiovascular care." When evaluating premiums, Darling suggested businesses ask for a breakdown of all priceas to determine whether it might be cheaper to outsource certain part of the such as prescription pharmacy benefits. Amonh the various types of employer-sponsored health insurance plans, managed-cars options dominate the landscape.
In its national survey of employee-sponsored health the consulting firm Mercer Human Resourcs Consulting found that preferred provider organizations were the most popular optionin 2006, at 61 followed by health maintenance organizations at 24 percent. Both HMOs and PPOs have contracts with networkdsof physicians, hospitals and other health-care networks. Members pay less for services provided "in-network," but typically have the optionxs of paying higher "out-of-network" fees to going to providers not in the HMOs are more restrictive by having members selectr a primary-care physician who must approve visitw to specialists.
PPOs typically carryg slightly higher deductiblesand co-payments, but no restrictions on visits to specialists - making the option generally more favorabler to members. In order to hold down premiums, managed care plans are increasingly offering customers a tie red pricinyg planfor pharmaceuticals. Members pay the least for generic slightly morefor brand-name products in the plan's formulary of approved and the most for brand names drug not on the formularyu list. Traditional indemnity coverage, whicb accounted for about 50 percentof employer-sponsoredx plans in the early 1990s, has steadilty plunged during the past decade and hit just 3 percenyt last year according to the Mercer survey.
The newest option is consumer-directed or consumer-driven healthj plans, abbreviated as Chaps, which feature high deductiblee along with health savings accounts or healthgreimbursement accounts. With such employees and employers can makea pre-tasx contribution to a health savings which is used to pay for routine medicak care. Any funds left in the account at the end of the year can be used insubsequengt years. If the fund is depleted, the employee's coverage converts to a high-deductible managed-care plan. Proponentw of Chaps say they help people becomdebetter health-care consumers because theif own money is involved.
Criticsz fear people will put off necessary treatment to avoid emptyingtheirt accounts. "They are not the right choice for everyu employer orevery employee, but they can help both employera and employees save money," said Jessica Waltman, vice president of policyu and state affairs for the Nationakl Association of Health Underwriters in Va. Waltman said some younger, childless employees decide to opt out ofan employer's plan because they typicallyy don't get sick or even go to a doctor'as office.
"A consumer-directed plan is a way to entice younger workers to go into the company healthinsurance plan," she said, noting the feature that allowx people to rollover unused funds for future health-care services. "Therse really are a wide array of healtb plansout there, but most people (in employer-sponsored plans) end up with a PPO product because of pricing," Waltman said. Waltman also said employeees are attracted to PPOs because they alloew members the ability to go to any docto r inthe plan's network without a referral. "Employers will gravitatre to whatemployees like," she said.