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Business health insurance: 10 things you should look for

While most people in the workforce appreciate getting business health insurance from their employers, few enjoy spending time comparing different plans and reviewing their options. However, diligent research is essential to find the right balance of cost and benefits for you and your family.

Business health insurance plans typically offer you a choice for the type of coverage you can receive – the more flexible the plan, the more you’ll pay. Whether it’s an affordable HMO with low fees and many restrictions or a more popular PPO with more options but higher cost, you’ll have to choose a plan based on your specific health care needs.

Obviously, selecting the right business health insurance isn’t easy. To help, we’ve compiled a list of 10 aspects of health insurance plans you should examine before selecting one.

What to look for in business health insurance

  1. Selection - Business health insurance providers keep costs low by getting several medical providers to agree to specific rates. You’ll either have to pick a primary care physician (PCP) or choose a doctor listed when you need service. Also, you’ll have to get referrals to specialists. If your current doctor is a listed provider, you’re in luck. Otherwise, you’ll have to perform your own research the find the best PCP.
  2. Location – Think about how far you have to travel to get to your doctor. Do you want a doctor closer to home or office? What if you need care while out of town? You want adequate protection for emergencies when you can’t get to your PCP or get a referral.
  3. Costs – You’ll likely be responsible for a portion of your business health insurance premiums and expenses. Get clear details for what your company covers and how much you must pay for individual and family coverage, deductibles before the insurance company pays its share, and prescription drugs.
  4. Flexibility - Think about what’s most important to you and your family: keeping costs low or providing more options? Most business health insurance plans require you to choose a doctor from a limited list, but doing so keeps your costs under control. Consider your typical health care needs to decide what’s best.
  5. Future preparation - A big mistake would be to only think about your current situation. Make sure your business health insurance can adjust as you experience life changes such as starting a family, approaching retirement age, caring for elderly relatives, or paying for major surgery. Most plans allow you to make immediate adjustments for life changes without waiting for your company’s annual enrollment period.
  6. Main features – While it can vary from provider to provider, most plans cover physicals, health screenings, ambulance service, emergency room visits, and hospitalization. You may also be eligible for other benefits such as prescription drug discounts and vision and dental plans.
  7. Additional features – Depending on what your employer offers, your business health insurance might also provide assistance with mental health care, addiction prevention, family planning, physical therapy and rehabilitation, and chiropractic services.
  8. Coverage - Find out what’s covered and what the limitations are. Does a plan cover preexisting illnesses or specific ailments? Is there a gray area for certain experimental surgeries or treatments? Knowing ahead of time will prevent you from running into problems down the line.
  9. Limits – If you’re concerned about serious ailments and major surgeries, check the dollar limits on each business health insurance plan. Providers may cap the amount they’ll pay out in a year – or in a lifetime – and you want to ensure you’re not left paying the bulk of very expensive hospital bills. Your employer may offer health savings accounts or flexible spending plans so you can supplement your coverage to prepare for these costs.
  10. Problem solving - Find out what the procedures are for resolving any business or coverage issues. You should be able to contest reimbursement levels if they seem low or claim rejections if you have valid symptoms. Check the official complaint records from your state’s Dept. of Insurance to review grievances against a provider; avoid working with one that has a lot of past complaints or outstanding grievances.
For more information on the different types of business medical insurance options available, read our overview on offering health plan choices to employees.



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