Health insurance can be a challenge. But there are ways to overcome the financial obstacles and get the coverage necessary for your business. There are two significant benefits of employer-based coverage. First, these plans, although expensive, usually carry the best all-around protection for you and your employees. Second, providing benefits plays a crucial role in attracting and retaining quality employees.
Why is coverage for small businesses so much more than for large corporations?
Health insurance for small businesses costs so much because of the high-quality coverage concentrated among a small group of people. Every individual within the group represents a different level of financial risk to an insurance company, and this risk is added up and spread out among the group. Large corporations pay considerably less because of the risk spread to such a large group, where small business owners can see unreasonably high increases in premiums due to one or two members. Small businesses also have to insure their employees under state mandates, which can require the policies to cover some specific health conditions and treatments. Large corporations’ plans are under federal law, usually self-insured, and with fewer mandated benefits. The Erisa Act of 1974 officially exempted self-funded insurance policies from state mandates, lessening the financial burdens of larger firms.
Isn’t the Health Care Reform Bill going to fix this?
This remains to seen. There will be benefits for small business owners in the form of insurance exchanges, pools, tax credits, subsidies, etc. But you can’t rely on a bill that is still in the works, and you can’t wait for an invoice where the policies set forth won’t take effect until about 2013. Additionally, the bill will help you with costs but still won’t prevent those costs from continually rising. You, as a business owner, will need to be fully aware of what you can do to maintain your bottom line.
What can I do?
First, you need to understand the plan options out there. So here they are.
A preferred provider option (PPO) is a plan where your insurance provider uses a network of doctors and specialists. Whoever provides your care will file the claim with your insurance provider, and you pay the copay.
Who am I allowed to visit?
Your provider will cover any visit to a doctor or specialist within their network. Any care you seek outside the system will not be covered. Unlike an HMO, you don’t have to get your chosen doctor registered or approved by your PPO provider. To find out which doctors are in your network, simply ask your doctor’s office or visit your insurance company’s website.
Where Can I Get it?
Most providers offer it as an option in your plan. Your employees will have the opportunity to get it when they sign their employment paperwork. They generally decide on their elections during the open enrollment period, because altering the plan after this period won’t be easy.
And Finally, What Does It Cover?
Any first office visit within the network that is will cover under the PPO insurance. There will be the standard copay, and dependent upon your particular plan, other types of care may include. The reimbursement for emergency room visits generally ranges from sixty to seventy percent of the total costs. And if you must be hospitalized, there could be a change in the reimbursement. Visits to specialists will be covered, but you will need a referral from your doctor, and the specialist must be within the network.
A PPO is an expensive, yet flexible option for your small business health insurance. It provides excellent coverage, though, and you should inquire with your provider to find out how you can reduce the costs.
HMO (Health Maintenance Organization)
Health Maintenance Organizations (HMOs) are the most popular small business health insurance plans. Under an HMO plan, you will have to register your primary care physician, as well as any referred specialists and physicians. Plan participants are free to choose specialists and medical groups as long as they covered under the plan. And because HMOs are geographically driven, the options may be limited outside of a specific area.
Health maintenance organizations help to contain employer’s costs by using a wide variety of prevention methods like wellness programs, nurse hotlines, physicals, and baby-care, to name a few. Placing a heavy emphasis on prevention cuts costs by stopping unnecessary visits and medical procedures.
When someone does fall ill, however, the insurance provider manages care by working with health care providers to figure out what procedures are necessary. Usually, a patient will be required to have pre-certification for surgical procedures that aren’t considered essential, or that may be harmful.
HMOs are less expensive than PPOs, and this preventative approach to health care theoretically does keep costs down. The downside, however, is that employees may not pursue help when it is needed for fear of denial. That aside, it is an accessible and affordable plan for your small business health insurance.
POS (Point of Service)
A Point of Service plan is a managed care insurance similar to both an HMO and a PPO. POS plans require members to pick a primary health care provider. To get reimbursed for out-of-network visits, you will need to have a referral from the primary provider. If you don’t, however, your reimbursement for the visit could be substantially less. Out-of-network visits will also require you to handle the paperwork, and meaning submits the claim to the insurance provider.
POSs provide more freedom and flexibility than HMOs. But this increased freedom results in higher premiums. Also, this type of plan can put a strain on employee finances when non-network visits start to pile up. Assess your needs and weigh all your options before making a decision.
An Exclusive Provider Organization Plan is another network-based managed care plan. Members of this plan must choose from a health care provider within the network, but exceptions can be made due to medical emergencies. Like HMOs, EPOs focus on preventative care and healthy living. And price wise, they fall between HMOs and PPOs.
The differences between an EPO and the other two organization plans are small but essential. While particular HMO and PPO plans offer reimbursement for out-of-network usage, an EPO does not allow its members to file a claim for doctor visits out its network. EPO plans are more restrictive in this respect but are also able to negotiate lower fees by guaranteeing health care providers that its members will use in-network doctors. These plans are also arranged on a fee-for-service basis, whereas HMOs are on a per-person basis.
HSA (Health Savings Account)
An HSA is a tax-advantaged account used to pay existing and future medical expenses. HSAs are used in conjunction with high-deductible health plans (HDHP), which will make some with pre-existing conditions ineligible. Also, HSAs must be funded with cash. Communicating the terms of this account to your employees is essential, as a large number of HSAs are underfunded or improperly funded. The health savings accounts were signed into the law by George Bush in 2003, and have become an affordable alternative to a group health plan.
When inquiring about an HSA, there will be a few things you will want to clarify. While HSAs generally cover routine medical expenses and copays, some can provide dental and vision care as well. And since HSAs can be combined with specific compatible plans, it is crucial to understand how money from the account will be allocated. And finally, you will want to know about cashing out your HSA balance. The amount is taxable and could be subject to a ten percent excise tax.
HRA (Health Reimbursement Arrangement)
An HRA is what it sounds. The employer reimburses the employee for health care. As an employer, you will usually have the option to contribute to a reimbursement fund or to pay fees as they are incurred. These reimbursements can be deducted from your taxes, and are tax-free for your employees, saving you both money.
Some providers empower employers by giving them more options. HRAs, unlike HSAs, don’t have to be funded with cash, placing a bookkeeping entry on your balance sheet is enough. You can usually control aspects of your arrangement, such as reimbursement limits, whether you or your employee pays first, and if the previous year’s funds roll over.
HRAs are becoming a more popular option because of the control it has given small businesses. Combined with a high deductible health plan (HDHP), an HRA could be the most cost-effective solution to your small business health insurance problems. It’s always best to compare these plans to PPOs, HMOs, and EPOs to know what works best.
Fee for Service (FFS) or Traditional Indemnity
A price for the service plan is the most flexible small business health insurance option. You choose your doctor and your hospital. You can see a specialist without a referral. This flexibility, however, comes with more out-of-pocket expenses and higher insurance premiums.
The typical FFS plan has a deductible ranging anywhere from five to fifteen hundred dollars. After this amount is reached, the provider will pick up eighty percent of your medical bills, and require you to pay the remaining twenty percent. Because of the rising costs of health care, and the potential for a small number of doctor’s visits to cost thousands, these plans can become incredibly expensive.
Flexible Spending Account (FSA)
A flexible spending account is a savings account to be used for medical expenses and is funded by pre-tax dollars. Using pre-tax dollars means that your employees will actually show that they have less income, and will, therefore, have fewer taxes withheld. As an employer, you set the limit on contributions to the account per year. In addition to the employee contribution, you can also credit the account or fund it completely from your general assets.
An FSA, especially if combined with an HDHP, can significantly reduce the costs of small business health insurance.
You should be forewarned; money from FSA accounts cannot be rolled over. They are, however, available to use for two years and two and a half months after the benefit year. A terminated employee won’t be able to use leftover funds unless there is a remaining positive balance, and COBRA is elected.
Small business health insurance providers have made significant improvements in their services to simplify the administration of your plan. With HRAs, FSAs, and HSAs, your employees can use debit cards for medical transactions. Be sure to research this thoroughly. You will want to be sure your debit card plan is IRS compliant, and that you can use a large number of pharmacies. You should also pick a project that can verify eligibility on the spot. Talk with your agent about linking transit, parking fees, and prescriptions to the same card. When picking the debit card options, please be sure to clarify the details of the substantive process. This is IMPORTANT! With other plans, the provider may assign someone to manage your project. Or you may have to hire someone. Still, you should be able to login to your account and print insurance cards, important papers, etc.
The next thing you can do is thoroughly assess your needs. Being that every member of your small business plays a crucial role in its success, their needs must be met. And understanding these needs is essential in finding the right plan. Find out about chronic illnesses and additional information related to past health issues. Know what your employees think about health insurance, and get them involved in the process.
Hiring an agent or a broker
Finding and understanding small business health insurance can be a daunting task. While some choose to go it alone, others need some professional assistance. You need to understand the difference between an agent and a broker, and how you can get the most from either of them.
Brokers function independently and usually work for several different companies. Since they have a variety of resources, they can generally provide more options and a better overall view of the marketplace. Brokers will assist you by evaluating the costs and designs of plans from your major local carriers. The price isn’t everything, and you want to get the coverage that you need.
Ask the broker how he or she is getting paid for their services. They should readily divulge that information. Some brokers may charge you a flat free. Some receive a fee from an employer, while others receive a commission from the insurance provider. Any commissions could be reflected in your premiums, but not to the point that you should worry.
Agents typically provide services for one company. They have a closer relationship to the insurance company than a broker would, giving them more leverage to make alterations to your plan. In some cases, they can offer a particular program for less than a broker and may have access to additional services like worker’s compensation. To find out what different providers have to offer, talk to more than one agent. It may be time-consuming, but it could bring you closer to the most cost-effective solution for your small business health insurance.
One of the standard options presented by agents is the employee-elect option. This is an arrangement where employees pick the plan they prefer. Those who don’t need as much coverage won’t be forced to pay so much, and those who do need it can get it without increasing the financial burden of the company as a whole.
How to Save On Your Small Business Health Insurance Plan
What’s important to remember is that there is no inexpensive solution to health care. Even if your initial premiums are reasonably low, they could rise significantly at your next renewal. So saving money on small business health insurance is about doing a combination of things simultaneously to get reasonable rates and to maintain those rates then.. And it will require a consistent effort from you, your employees, and your insurance provider.
First, you can save yourself money by reading the fine print. You need to know what your plan does and DOESN’T cover. There are also state mandated coverages. For example, in states like Illinois, your insurance must cover mammograms. Also, understanding the ins and outs of your plan will give you and your employees a better idea of how to deal with your insurance.
Next, you should have additional benefits. After reading all about your plan, you will find coverage for things you may not need. Eliminating these benefits can significantly drop monthly small business health insurance premiums. For example, eliminating coverage for brand name medications can reduce costs by more than 25 percent.
The wellness program has worked wonders for small businesses. A wellness program is any program designed to promote healthy living within the organization. Weight loss competitions benefit every participant. Add a financial incentive for further motivation. Stock the work fridge with water, and leave literature about healthy living lying around. Search the internet for calorie counting charts. You are raising awareness to entice workers to make positive changes. Active, exercising, diet-conscious employees have more durable immune systems, more vitality, and more productive workplaces. They also don’t deal with as many health issues. Fewer doctor visits and hospitalizations will help maintain lower annual premiums because it will prove to your insurance provider that your business is a low financial risk.
Increasing your co-pay and deductible can go a long way towards cutting costs. For instance, raising co-pays by just ten dollars has saved companies as much as thirteen percent on their premiums. A higher deductible will significantly reduce your monthly premium. To lessen the financial burden of high-deductible health plans (HDHPs), combine them with an HSA. Combinations like these have saved both business owners and employees bundles of cash.
Check into getting a nurse hotline. A nurse hotline is a toll-free, 24-hour-a-day, seven-day-a-week service. Employees can get medical advice from qualified registered nurses. This method has deterred a large number of people from emergency visits, and it can also be used for preventative care as well. Insurers like Nationwide have them, or you may have to purchase from a third-party provider.
Increase the size of your group to reduce your monthly small business health insurance premiums. In a survey by America’s Health Insurance Plans, small businesses who employed ten people or less paid forty-three more dollars on average than companies with twenty-six to fifty employees. Check around with other business owners or fellow members of business organizations. Some states also have small business groups and pools for this purpose. Check with your state Chamber of Commerce and the Department of Insurance.
Beware of heavily discounted plans. First, there are numerous scammers trying to get your money. They promise low rates and usually cover little to nothing at all. The internet is notorious for swindlers trying to hustle you out of a buck. If you are going with a company you aren’t familiar with, please do your research. On another note, even reputable companies present problems. In an attempt to gain market share, Blue Cross offered small businesses discounted rates in 2008. For 2009, some of these same businesses were set to see increases of as much as 47% in their premiums. As the costs of medical care increase, the prices are shifted from the insurer to the insured, and discount plans become overpriced plans quickly.
Shop around. As mentioned before, talking to different agents will expose you to the best that insurance providers have to offer. Ask other small business owners about their providers. You can use trusted online resources like Netquote and Ehealthinsurance to shop around instantly. These services also let you compare plans side by side and allow you to purchase your policy online. Even after you get your initial idea, it’s good to reevaluate your coverage annually. This will keep you on the up-and-up about what the market is offering. Keeping costs down is an ongoing effort, especially with rates and plans changing all the time from company to company.
Share some of the costs with your employees. Raising employee contributions isn’t a popular option, but it may be one of the only ways to absorb costs and maintain small business health insurance coverage. Communicate with your employees about how to keep costs down, and remind them that their increase is your increase as well.
The sad truth is that, no matter how many cost-cutting methods you apply, your insurance premiums are expected to rise continually. In addition to this, you can’t prevent every health problem with exercise and higher copays.