How to Make Sure You’re Receiving Proper Employee Health Benefits Insurance

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How to Make Sure You’re Receiving Proper Employee Health Benefits Insurance

Many small businesses may meet or exceed the threshold that makes it necessary for them to offer their employees health insurance plans and other benefits. Given the rising trend of remote work, hybrid workplaces, and the availability of affordable part-time and full-time employees, more business owners have started examining their options regarding health insurance plans.

Not all employees are well-versed in what to look for in employer-sponsored healthcare plans. Just because employers may support part of the cost doesn’t make all plans equal. Sometimes you can still be better off not choosing a plan provided by your company or organization.

It all comes down to weighing the benefits, understanding the cost breakdown, and looking at various other factors before deciding. The right plan can give you better coverage and savings, while the wrong one can cost you more money down the line.

Look at the Cost
Not all employee health benefits insurance is created equal. Some plans benefit employees more than others, and the differences are often reflected in the price. If you’re working for a reputable employer, chances are you have already received numerous documents outlining the costs of the health care plan.
Looking closely at the numbers and understanding them is essential. You must know the coinsurance costs, copays, premiums, out-of-pocket maximums, and potential deductibles outlined in the insurance papers.
Another aspect worth checking is whether the insurance is offered to individual employees or if it’s part of a group health care plan. Group insurance is cheaper because carriers charge lower premiums and employees can share the cost.

Understanding the Numbers

There are three key figures needed when comparing employee health benefits insurance plans.
·         Premiums are the monthly amounts charged by insurance providers that you can split with the employer.
·         Deductibles refer to how much employees must spend for their insurance coverage to activate insurance coverage or reimbursements. These figures reset yearly and can range from hundreds to thousands of dollars.
·         Copays aren’t always deductible. These are charges the employee may have to make in addition to the monthly premiums when visiting a doctor.

Check the Coverage

Naturally, premiums aren’t everything when it comes to determining what a proper employee health benefits insurance plan looks like. Check out some plan options at to understand some of the differences.

Make no mistake. Premiums are an essential consideration, and employees earning minimum wage often value discounts more than anything else. But sometimes, the coverage is more important.

To determine what matters most to you, try to figure out your annual healthcare costs. If you have a disability or chronic condition, you may need lower deductibles, even if it means paying higher premiums.

You may want lower deductibles and better coverage if you plan to start a family, need surgery, buy expensive medication, or expect to incur more medical expenses in general. Alternatively, you could opt for low premium plans and higher deductibles if you don’t think you’ll need much medical care.

Check the Network

Usually, employee health benefits insurance utilizes health maintenance organizations (HMO) or preferred provider organization (PPO) plans. Understanding these two options is key to ensuring you get proper benefits or the best personalized employer-sponsored insurance.

Ideally, you want an insurance plan covered by a broad network of providers. PPOs, or preferred provider plans, may have well-defined networks of hospitals, doctors, and clinics. However, employees can also occasionally go outside said network and still use their employer insurance. This isn’t possible with HMO plans, which are known for their inflexibility.

But not everyone wants flexibility. Some employees may need to continue seeing physicians and specialists in a particular network. It helps people suffering from chronic illness or those with a long patient history.
If you want to keep seeing the same doctors, you must ensure that the employee benefits insurance plan’s network overlaps with your doctors. Doctors outside the network will still see you, but you may have to pay a lot more for consultations and treatments.

Alternatives to PPOs and HMOs

There are two more types of health insurance employees can sometimes get courtesy of their employers. An exclusive provider organization (EPO) plan means that the insurance may pay or reimburse for select services carried out by specific providers.

Another plan you may run into is the point of service (POS) plan. This one shares similarities with HMO plans, like requiring a referral to benefit from certain services. Some POS plans may still pay for out-of-network services, which isn’t an option with HMOs.

See if the Plan Is Qualified

Not every employer must provide employees with benefits and health insurance plans. Businesses with 50 or more full-time employees must present qualified health plan options to their employees to avoid financial penalties.

But that doesn’t mean all plans are considered qualified. According to the Affordable Care Act, a qualified plan must meet specific criteria and cover 10 specific benefits.

·         Prescription drug benefits
·         Pediatric care
·         Emergency treatments and emergency room visits
·         Outpatient care
·         Inpatient care
·         Health coverage during maternity and for newborns
·         Substance abuse and various mental health treatments
·         Recovery and rehabilitation services
·         Laboratory services
·         Health screening, vaccination, and other wellness or preventive services

Get the Plan That’s Right for You

Every employee may have unique health insurance needs and expectations. That’s why rushing to commit to a plan is seldom a good idea. People with unique medical conditions, work arrangements, or specific family situations must do their due diligence before making such a critical decision regarding their healthcare options and finances.

Luckily, it’s easier to compare plans once you understand how to break down the cost and what benefits matter more than others in certain situations. And if you’re lucky to have a great employer, you may have multiple options to choose from or even the perk of customizing your own health insurance plan.