Low Cost Group Health Insurance

Much has been said lately in these pages and elsewhere about the changing nature of today’s health insurance system. And much of the ballyhoo has been focused on the growing trend towards more consumer driven health insurance. And while more and more people are shopping for individual health insurance plans, and many companies have been forced to eliminate or cut back on employee health benefits, still there are many small to large companies that want to purchase affordable group health insurance. And it is equally important, in fact maybe even more important that they too become just as savvy as health insurance shoppers as their individual counterparts.

Any group health insurance plan, no matter how affordable or good it sounds will have limitations, be sure that you understand the level of those limitations before buying into the group for yourself and your employees. Do not accept the plan based on a summary of benefits. A summary of health insurance benefits is just that a summary. Talk to a representative of the company or a qualified health insurance agent for the complete details of the plan. Do not be afraid to ask questions and be sure that you clearly understand the exclusions on the policy. Check to see if the company is financially sound, and how they have been rated.

Some of the key factors you need to be aware of when comparing one seemingly affordable group health insurance plan to another are:

• Out of Pocket Expenses – Out of pocket expenses are typically deductibles and co-pays. Are there different co-pays for different types of healthcare? What is the cap or maximum pay out? Are there only payments for certain amount of visits for certain types of treatments for instance, Mental Health or CAM (Complementary and Alternative) treatments?

• Emergency Room Visits – what is considered an emergency treatment by the group health insurance plan? Is prior approval necessary for an ER visit? Most employees would reject such a plan and expect payment for ER visits to follow the Prudent Lay Person guideline – meaning the group plan you select should pay for any trip to the ER that any reasonable person felt was necessary

• What is the burden of Paperwork? – are reimbursements necessary or does the plan make all payments direct to the healthcare providers?

• What is their grievance procedure and how does their record stand on past grievances? You should also check with your local Better Business Bureau, States Division of Insurance, and States Attorneys General Office for any complaints filed against any health insurance company you are considering acquiring affordable group health insurance from. And of course speak to your peers and other business people who may have used that group plan and get their feedback.