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How to Choose a Group Health Insurance Plan

Posted By on Dec 16, 2015 | 0 comments


As a small or mid-sized business owner, you understand the value of providing quality health insurance to your employees. Even better, the Affordable Care Act made it easier for business owners to opt into a group health insurance plan. But when you log into Covered California’s Small Business Health Options Program (SHOP), you might feel overwhelmed at your options. How do you get started, and which plan is right for your employees? Here are a few pointers to get your started.

Don’t look at price first. It’s human nature to look at the price tag first. But resist the urge to focus on cost, and compare the merits of different plans. Once you have done this, you will have a better idea of what type of group health insurance plan is right for your business. It’s best to discover what features are truly important to you. Then you can look at price tags and compare plans.

Consider your coverage limits. Group health insurance plans offer coverage limits, or the amount of health care bills they will pay before you or your employees are responsible for the balance. With the cost of health care rising rapidly, you want to select a coverage limit that is realistic for the majority of situations. Remember that there are two types of coverage limits: Per claim limits and lifetime limits. A lifetime limit is exactly what it sounds like. A per claim limit refers to the amount your health insurance company will pay toward a single illness or incident. For example, a the emergency care, surgery, and physical therapy following a single car accident will count as one claim.

Look for internal policy limits. Even if your per claim limit is reasonably high, your policy might impose further limits on coverage for certain types of medical care. For example, your employees might be limited by an internal policy limit of $5,000 for an appendectomy. If their medical bills exceed this amount, they will be responsible for the balance even if their per claim limit is much higher.

Decide upon a network type. A plan might be a HMO, PPO, POS or EPO. This refers to the network of providers which you and your employees can access. A network-based plan can limit costs, and pass those savings on to you, but your treatment options might also be more limited. Consider whether a network plan includes enough providers in your area, and how your employees might feel about these limitations.

As a business owner, you face complicated decisions every day. But since few are as important as the health of your employees, why not consult a health insurance expert before choosing a group health insurance plan? Call us at (650) 854-8963 for more information.

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