Questions to Ask When Buying Group Health Insurance

Employers offer group health insurance for numerous reasons. It helps attract and retain talented employees. It allows employers to negotiate more profitable rates and coverage options through providers, and they can show, through the offering of group health insurance, that employers care and value their employees’ well-being.

Group health insurance is beneficial for both the employer and the employee. For employees, group health insurance is a more affordable alternative to individual health insurance and offers protection for themselves and even their family, depending on the policy. Group health plans, for employees, also offer more comprehensive care than individual health care plans would.

That all being said, not all group health insurance policies are built the same.  There are multiple different types: PPPO, HMO, POS, EPO – and even additional variations between each separate type of plan. In this blog post, Hitchings Insurance will go over all the most important questions to ask when buying group health to ensure you get the best choice that suits your employees, helps retain and attract top talent, and is most beneficial to your business’ benefits plan.

6 Main Questions to Ask: How to Buy Group Health Insurance as an Employer (Before Choosing a Plan)

Before choosing a plan, make sure to take your time and assess all possibilities. Here are some of the main questions we believe you should ask when selecting group health insurance.

1. What plan options are available and what are their respective benefits and costs?

What different types of plans are available? Multiple types of group health policies exist, including HMO, PPO, POS, and EPO. What’s the difference between them in terms of benefits, costs, and provider networks?

Ask about monthly premiums for each plan option, and what percentage you may be required to subsidize. What makes it most affordable for your employees? For you?

Ask about discounts, or even cost-sharing options, including wellness incentives or health savings accounts (otherwise known as HSAs.) Finally, inquire about the total cost of the plan, including all copays, coinsurance, and deductibles.

2. What is the plan’s prescription drug coverage, and does it have restrictions?

How are drugs categorized – especially in terms of cost/coverage? Are there restrictions for certain medications, such as step therapy requirements or prior authorizations?

Ask about the out-of-pocket cost for each tier of drugs. Are there any available programs that exist to help employees save on their prescription costs?

3. What is the plan’s deductible? Co-insurance and copayment structure? How do these impact out-of-pocket costs?

How does the deductible of the plan work with other, existing cost-sharing measures, like coinsurance and copay? Ask about an out-of-pocket maximum – and how does that work with individual/family coverage? Are employees able to access preventative care services through the plan – and do those services have 100% coverage without cost-sharing?

4.  What additional benefits does the plan include (vision, mental health, dental, wellness)?

Additional benefits can go a long way with your group health plan. Be sure to ask about coverages for dental, mental health, vision, or wellness programs.

Ask about the extent of coverage for each potential benefit, and if there are any restrictions or limitations with each option.

5. How are the plan’s claims and appeals handled? Is there a process for resolving disputes?

Ask about the claims submission process, and how long it may take to receive payment.

Also, be sure to ask about the process of appealing for a denied claim/coverage decision, and what the requirements and timeline are for doing so. Ask about potential resources that help employees navigate the claims/appeals process, including an online portal or customer service hotline.

Main Questions to Ask: During Group Health Enrollment and Renewal

While the questions you ask prior to choosing a plan are critical, also consider how enrollment of the plan and renewal are handled. Consider the following questions:

Is there a deadline required for enrollment? Who is eligible?

Always ensure you ask about enrollment periods and who is deemed as “eligible” to enroll in a group health plan. Inquire about restrictions regarding dependents and family members, and if there is any documentation needed to enroll these individuals as well.

Our professionals can provide you with information regarding the enrollment process and what info is needed to make sure every employee is taken care of the same way, even when coverage is waived.

How are employees notified of plan changes?

Ask about how employees may be notified if their plans change, and ask about what resources are available to help them best understand what benefits are available.

Be sure to request the availability of a communication channel, where employees can ask questions, offer feedback, and submit changes.

Finally, ask about educational materials/resources so that employees may make informed healthcare decisions.

Alternatives to Group Health Insurance

Group health insurance is an extremely popular choice for employers, but it isn’t the only choice that exists. Some alternatives include:

• Individual health insurance, where employees may purchase individual health on their own via an insurer or marketplace.
• Health savings account (HSA), which are tax-advantaged accounts used to pay for qualified medical expenses.
  • Employees may contribute to an HSA and use that money to pay for out-of-pocket healthcare costs, such as copays, deductibles, and coinsurance.
  • HSAs can also be used in conjunction with high-deductible health plans, or other types of insurance.
• HRAs are an option – also called “health reimbursement agreements” – and can be used to reimburse employees for qualified medical expenses.
  • These accounts can also be used in conjunction with individual health insurance.
  • Employers may set these up to cover all or a portion of healthcare costs. Unused funds can rollover to the next year as well.

These are just a few alternatives to group health insurance, which employers can weigh the benefits of to find the option that best meets their budget and employee benefit needs.

Give the professionals at Hitchings Insurance a call to discuss our offerings for group health insurance, the variety of plans available, and which is the best option for you and your business.