What to look for in a group health quote

At least once a year, it’s on every employer and benefits manager task list – to review your group health plan. No matter if your plan runs on a calendar year basis or other timing, often this process involves being handed a spreadsheet comparing multiple health plans and/or insurance carriers for your business.

Price, of course, is a major point of your evaluation. Employers have a bottom-line for their business to keep in mind while also prioritizing the health of their employees. A healthy workforce makes for a healthy business, after all. The cheapest plan, however, may not be the right choice for you and your employees. With many nuances, details, and variations in coverage for each plan option, you are actually seeking the best value for your team. 

Here are a few things to consider next time you are reviewing a quote for your group health coverage:

Compare the Details

Before you jump immediately to the bottom-line, it’s important to review the finer details. When you have your group health quote in front of you, compare the sections that include the following:

• Network
   
  • Do a quick network analysis. Make sure you are looking at the same network scope in your comparison, such as the number of in-network providers or exclusion of certain health systems.
     
• Deductibles
   
  • Deductibles can range greatly from plan to plan. Also, compare if there are different deductible levels for out-of-network coverage.
     
• Out-of-Pocket Maximums
   
  • Out-of-pocket maximums can be a deciding point for employers in determining the best plan selection for their team.
     
• Co-Insurance
   
  • Does the health plan include co-insurance or not? Will employees have copays at visits or do they incur more upfront costs when using services? It’s important to understand these terms before deciding what plan is the right fit for your business.
     
• Pharmacy Benefits
   
  • Do the pharmacy benefits include co-pays or co-insurance? What about high-cost specialty medications? Are these medications included or excluded with the plan. Some carriers exclude coverage for specialty medications to offer a lower premium to employers.
     
• Benefit Limitations/Exclusions
   
  • Certain procedures or medications can be excluded from a plan, or have limitations on visits or dollar amounts. Make sure you are comparing apples-to-apples when looking at multiple plans and carriers.

Value Added Benefits

Let’s connect the “value” portion of the quote that may not be addressed in the price tag alone. Other services and resources are often included, but not listed in the benefit plans with your quote. For example, at PHP we automatically include the following value-added benefits with our plans:

• Telehealth Services
  
  Telehealth services offer immense value to health insurance plans for businesses by enhancing accessibility, convenience, and cost-effectiveness of healthcare. Through telehealth, employees can access medical consultations, therapy sessions, and even specialist appointments remotely, eliminating the need for time-consuming office visits. This not only saves employees valuable time but also reduces absenteeism and boosts productivity. In addition, telehealth can help lower healthcare costs for businesses by reducing unnecessary emergency room visits and hospitalizations. By providing timely and convenient access to healthcare, telehealth services contribute significantly to improving employee satisfaction, retention, and overall well-being, making them a valuable addition to any health insurance plan for businesses.
  
  PHP members receive access to our telehealth service Parkview OnDemand at no member cost share. With this service, PHP members get 24/7 access to a provider through a video or mobile app visit.
   
• Member Discounts
  
  Member discounts are an invaluable perk of health insurance plans, offering numerous benefits to members. These discounts can encompass a range of health-related services and products, such as gym memberships, local sporting events, and even arts and entertainment. Members can proactively invest in their health and well-being, potentially preventing future health issues and reducing healthcare costs in the long run. Additionally, these discounts incentivize members to engage in healthy behaviors and maintain regular check-ups, leading to better health outcomes overall. 
   
• Wellness Programs
  
  Wellness programs for employers offer tailored health initiatives such as health risk assessments, onsite flu shot clinics, quarterly health challenges, and health coaching. These programs foster a culture of health within the workforce, promoting preventive care, healthy behaviors, and team engagement. By addressing specific health needs and providing support for lifestyle changes, employers can boost morale, productivity, and ultimately reduce healthcare costs in the long term. Overall, investing in wellness programs demonstrates a commitment to employee well-being while yielding significant benefits for both employees and employers alike. PHP has an on-staff wellness coordinator whose main role is to assist employers and make the most of this value-added benefit.
   
• Diabetes Education
  
  PHP offers diabetes educational resources and tools to support members managing this chronic condition. These resources empower our members with knowledge about managing their diabetes effectively, including dietary guidance, exercise tips, and medication management strategies. By promoting proactive self-care and fostering a deeper understanding of diabetes, these resources can lead to better health outcomes, reduced complications, and enhanced quality of life for PHP members.
   
• Tobacco Cessation Programs
  
  In an effort to support healthy lifestyles, we have a variety of options to help members who want to quit their addiction to tobacco.
  
  We cover the following FDA-Approved tobacco cessation medications:
   
  • Nicotine patch
  • Nicotine gum
  • Nicotine lozenge
  • Nicotine nasal spray
  • Bupropion (Zyban™)
  • Varenicline (CHANTIX™)

Download our program brochure for more information.

Customer Service

Nothing can be more frustrating than not getting good service for a product that you have purchased. Health insurance is no different. Consider if a company routinely has complaints filed with the state’s department of insurance or local Better Business Bureau. How do they score for service in industry surveys? Better yet, listen to your employees. Chances are, if they are having customer service issues with your insurance carrier, you will hear about it. Selecting a partner who provides quality service, both at the employer and member level, will save you time, stress, and in the long run, money. 

Ask Questions

It’s vital to ask your benefits advisor questions if you aren’t sure or don’t quite understand a particular detail on your quote. You don’t need to become an insurance expert by any means, but asking questions will build your understanding of what to look for, both now and in the future. The better you understand the quote, the better you and your benefits advisor can partner to find the best solution for your business.

Also, make the effort to doublecheck the details. Incorrect demographic information or employee counts, for example, could have an impact on your quote. It’s best to be thorough to avoid any surprises late in the process.

If you are interested in getting a quote from PHP, contact your benefits advisor or contact PHP at 260-432-6690 or sales@phpni.com. We would be happy to sit down and have a consultation so we can customize the best plan for your business.