Bernardini & Donovan Insurance Services

Evaluating Group Health Plans

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Evaluating Group Health Plans

Evaluating Group Health Plans

Health plans vary tremendously, but the basic comparison factors are relatively simple – you should analyze benefits, price, and providers of any plan.

Providers

This is an important area you should investigate. Traditional insurance plans allow you to choose your own doctor but managed care plans include preferred provider organizations (PPOs), health maintenance organizations (HMOs), and point of service (POS) plans. These plans often restrict your choices of medical services providers to an approved list. The list could prove crucial in deciding whether to enroll in a given plan.

Price

Compare plans with similar benefits to determine which plan offers the best value for your money. Your employer might offer several options from which you could choose
  • Some companies offer a choice between two insurance plans.
  • Employers can also provide a basic insurance plan, but they allow employees to purchase more comprehensive insurance as a personal option.
  • Some larger companies offer multiple insurance plans.

Benefits

You should research the benefits of various plans to find what each cover. Assessing the following benefits will provide practical help in evaluating policies:
  • You should find out what co-payments are required for outpatient care and inpatient treatment.
  • Find out what kind of co-payments are required for generic or name brand prescriptions.
  • You should understand what your deductible options are and how they will affect the insurance premium.

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Group Health Regulations

Generally, California and Colorado regulations require small group health plans to enroll a minimum of 75% of eligible employees. Employers must pay a minimum of 50% of the employee only rate for health insurance, and may base that percentage on a specific health plan. The employer is not required to pay any portion of the cost to add dependents. State regulations also include the following restrictions:

Guaranteed issue

Every eligible person must be accepted, regardless of any pre-existing conditions.

Guaranteed renewal

Insurance companies cannot cancel policies because policyholders make medical claims.

Portability

You must have the option of continuing your coverage if you change jobs

Ratings Protection

Insurance companies face limits on the rates they can charge, so they cannot make group insurance premiums too high for groups with greater levels of medical risk.

Top Group Medical Insurance Providers

Some of California and Colorado’s group health insurance providers include Kaiser Permanente, Anthem Blue Cross, Aetna, Health Net, Blue Shield of California, and United Healthcare. These providers offer a variety of health plans, including; HMO, PPO, EPO, and HSA/HRA compatible plans

Questions about your Group Health Plans?

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