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A survey by America's Health Insurance Plans, an industrh trade group in Washington, D.C., found small-groupo coverage in 2006 averaged $312 per month for single coveragedand $814 per month for familty coverage. Helen Darling, president of the National Business Group on Healthin D.C., said that when evaluating plan options, employers shoul consider the quality of care provided to its members and not just the premiumn prices. First on her list is checking to make sure the insure is accredited by the Nationao Committee forQuality Assurance.
Next woule be reading through the plans' HEDIe (Health Plan Employer Data and Information Set) scores, whicn the NCQA accumulates to tracko plans on variousperformance measures. "You can find out thingzs like what percentage of their memberxs receivea beta-blocker after suffering a heart attack, Darling said. "I'd also make sure the physicians in theplan are, with very few board certified. And I'd want to see that the plan hasa 'centerss of excellence' program for certain procedure s such as organ transplants and cardiovascular care.
" When evaluating premiums, Darling suggested businessews ask for a breakdown of all pricee to determine whether it might be cheaper to outsourc e certain part of the plan, such as prescriptiom pharmacy benefits. Among the variouz types of employer-sponsored health insurance plans, managed-care optionsa dominate the landscape. In its national surveuy of employee-sponsored health plans, the consulting firm Mercer Human Resourcd Consulting found that preferred provider organizations were the most popular option in at61 percent, followed by health maintenance organizations (HMOs) at 24 Both HMOs and PPOs have contracts with networkxs of physicians, hospitals and other health-care networks.
Memberes pay less for servicesprovided "in-network," but typically have the optiond of paying higher "out-of-network" fees to goinf to providers not in the network. HMOs are more restrictive by havingb members selecta primary-cars physician who must approve visits to specialists. PPOs typicallhy carry slightly higher deductiblesand co-payments, but no restrictionds on visits to specialists - making the option generally more favorablwe to members.
In order to hold down premiums, managed care plan are increasingly offering customers a tie red pricing plan for Members pay the least forgeneric drugs, slightly more for brand-namde products in the plan's formulary of approvecd drugs, and the most for brand names drug not on the formulary list. Traditional indemnity coverage, which accountedr for about 50 percentof employer-sponsored plans in the earl 1990s, has steadily plunged during the past decade and hit just 3 percenft last year according to the Mercere survey.
The newest option is consumer-directed or consumer-driven health abbreviated as Chaps, which feature high deductiblezs along with health savings accountsd or healthreimbursement accounts. With such plans, employeesa and employers can makea pre-tax contribution to a healtb savings account, which is used to pay for routinee medical care. Any funds left in the accounf at the end of the year can be used in subsequent If the fundis depleted, the employee's coveragse converts to a high-deductible managed-care Proponents of Chaps say they help peopl e become better health-care consumers because their own money is Critics fear people will put off necessaryg treatment to avoid emptying their accounts.
"Theg are not the right choice for every employe orevery employee, but they can help both employers and employeese save money," said Jessica Waltman, vice president of policg and state affairs for the National Association of Healty Underwriters in Arlington, Va. Waltmaj said some younger, childless employees decide to opt out ofan employer'ss plan because they typically don't get sick or even go to a doctor' office. "A consumer-directed plan is a way to entice younger workers to go into the company healtyhinsurance plan," she said, notingt the feature that allows peoplwe to rollover unused funds for future health-carre services.
"There really are a wide arrayg of health plans out but mostpeople (in employer-sponsored end up with a PPO product becauser of pricing," Waltman said. Waltman also said employees are attractecd to PPOs because they allow members the abilitgy to go to any doctor inthe plan'xs network without a referral. "Employers will gravitater to whatemployees like," she said.