The number of health insurance plan options has increased dramatically during the past few years. The price continues to increase. Nonprofit organizations need to work within a strict budget and, at the same time, provide a valuable benefit to their employees. A method to evaluate the different benefit options is necessary. One way to examine different plans is to use a series of questions that fall into the three Cs: Cost, Coverage and Customer Satisfaction.

Cost

No health insurance plan will cover every expense. To get a better idea of what your costs will be under each plan, you need to look at how much your employees will pay for their premium and other costs.

• Are there deductibles your employees must pay before the insurance begins to help cover their costs?
• After employees have met their deductible, what part of their costs are paid by the plan?
• Does this amount vary by the type of service, doctor, or health facility used?
• Must employees make copayments for certain services, such as doctor visits?
• If employees use doctors outside a plan's network, how much more will they pay to get care?
• If a plan does not cover certain services or care that employees think they will need, how much will they have to pay?
• Are there any limits to how much employees must pay in the event they face a major illness?
• Is there a limit on how much the plan will pay for care in a year or over a lifetime?

Coverage

In choosing a plan, your nonprofit should try to determine what is most important to your employees. All plans have tradeoffs. Ask your employees:

• How comprehensive do you want coverage of health care services to be?
• How do you feel about limits on choices of doctors or hospitals?
• How do you feel about a primary care doctor referring you to specialists for additional care?
• How convenient does care need to be?
• How important is out-of-pocket cost of services?

Now, from the perspective of your nonprofit, ask:

• How much is the organization willing to spend on premiums and other health care costs?
• How much of the costs are the nonprofit's employees willing or able to share?
• Look at the services offered by each plan. What services are limited or not covered?
• Is there a good match between what is provided and what your employees value or need?
• Is there access to special equipment or medicines?
• Which hospitals are included? Are these considered the top hospitals in the area? What if special care is required at a special institution?
• Prescription drugs are becoming increasingly important in medical care, and costs for some medications can be very high. Does the plan cover prescriptions? Is there co-pay?

Find out what types of care or services the plan will not pay for, usually called exclusions. Find out what a participant can do if he or she disagrees with a plan's decision on medical care or coverage.

Customer Satisfaction (Quality of Care)

Quality is hard to measure, but more and more information is becoming available. Check with the Colorado Department of Health or Insurance Commissioner for more information on the plans you are exploring. You can also find out if the plan you are interested in has been accredited, meaning that it meets certain standards of independent organizations.

Another approach is to ask the plan carrier how they ensure good medical care. Do they review the qualifications of doctors before adding them to the network? Does the carrier review the services provided and does it make changes to correct problems? How do they resolve customer complaints?

Some carriers survey members about their health care experience. Ask the carrier for a report of the survey results. Some carriers are also beginning to produce report cards. These reports often include satisfaction survey results and other information on quality.

You can also talk to current members of the plan to gauge your employees' reaction to the plan's service. Ask how they feel about their experiences. How does their plan handle care when you are away from home? Are there enough of the kinds of doctors you want to see? Do you need a referral to see a specialist?

The staff at Nonprofit Resourceshas many years of experience helping organizations to determine the appropriate coverage. Give us a call if you would like to talk with us about our insurance programs.

Let us address one of your questions!

 

HOME | ABOUT US | PRODUCTS | NEWS & RESOURCES | CONTACT US | COMMON QUESTIONS
Privacy Statement | Terms Of Use

455 Sherman Street, Suite 207 Denver, CO 80203
Tel: (303) 894-0298 | Toll Free: (866) 537-1142 | Fax: (303) 894-0161 | Email