Employers

Choosing a Health Plan
When you carry the responsibility of selecting the best health plan for your employees, it is important to assemble as much information as possible about the various benefit plan options available to you. Because the impact of a health benefit plan decision can have far-reaching implications, it is helpful to have a checklist to assist in your decision-making.

A checklist of thoughts and questions might include:

Philosophy
Look for the philosophy of the health plan in its literature and benefit summary. A plan that stresses wellness is likely to remain more affordable over time due to the lower medical costs of its population.

Access
You want to be sure your employees have convenient access to providers and facilities within your local area. You also want to know what coverage the plan provides for emergency, urgent, and tertiary care outside the local area.

Quality
There are national measures of excellence that can be applied to health plans and its providers. Ask: Are the plan's facilities accredited by Joint Commission on Accreditation of Health Care Organizations (JCAHO)? What percentage of the plan's physicians are board certified? Have their professional credentials been thoroughly researched? Is the health plan following standards set by the National Committee on Quality Assurance (NCQA)? Positive answers to these questions indicate a plan that is pursuing excellence in healthcare.

Benefits
Consider the anticipated healthcare needs of your employees. Are there benefits in the plan for services that will be of value to your employees now and in the future? Will you be paying for additional benefits which won't be utilized by the majority of your employees?

Cost
In comparing health plans, the employer needs to consider premium cost, the insurance company's trend for adjusting premium at renewal, and the ability of the employee to pay out of pocket for their medical insurance and medical care. As a fixed cost, premium outlay can be easily projected; however, if the cost to the employee is too high, the employer risks employee dissatisfaction and lost productivity due to untreated personal or family illnesses. Taking a broad, long-term view of cost will probably lead to best financial decision for you and your employees.

Customer Service
A user-friendly health plan is critical to the development of a long-term relationship. Think of the range of administrative and medical issues that typically interact with the health plan: claims submission and payment, questions about benefits during routine or complex episodes of care, and authorization of services. Is the health plan helpful or a hindrance during these interactions?

Reputation
Ask a trusted friend, business associate, or healthcare provider what they know about the health plans you are evaluating. Consider the reputation of the plan within the community. This information will be helpful to you in making your purchasing decision.