Evaluating Group Health Plans

What Features Are Most Important in a Group Health Plan?

As you sort through group health plans, you will find that most cover hospital stays and emergency room visits. They also cover visits to the doctor, lab work, and routine diagnostic tests. Beyond the basics, what each plan covers really varies, so it is important to choose a group plan that covers the procedures that are important to you. Look for plans that cover maternity care including prenatal and postpartum visits, ambulance services, prescriptions, and mental health care.

Before you choose any particular group health insurance, research its policies regarding pre-existing health conditions and see what kind of provisions it offers concerning long term care.

Reimbursements

One of the most important things to consider when evaluating group health plans is reimbursements. If a plan has a low reimbursement level, the patient can be forced to pay a significant portionof their medical bills. It is always a good idea to only deal with companies that offer at least one million dollars of coverage as a maximum payment. That seems like a lot of money, but an extended illness or continual hospital stay can be extremely expensive and you want to make sure that you are completely covered. When looking at PPOs make sure that their deductibles aren’t unreasonably high.

What Doctors are Available?

Because so many people base the insurance they use on the availability of a particular doctor on that plan, it is important to know what doctors participate in the group health plans you are considering. Find out how many doctors in each group plan are board certified as specialists in one area or another. Only consider group health insurance plans that have at least 85% of their doctors certified by the American Board of Medical Specialties.

Do some homework and find out how many of the group health plans doctors actually accept new patients. Learn what the physician turnover rate is with any insurance plan you are considering. If the turnover percentage is more than 5% you want to avoid that particular group plan.

How Are Grievances Resolved?

The last area you should research when looking over group health care plans is grievance resolution. Superior companies have a set procedure in place to deal with grievances that are voiced by plan members. Ideally they will have a grievance board set up to fairly and quickly deal with disputes.

Make sure that in the event of an unfair charge or lack of reimbursement, your employees have options for protesting their treatment.

Before you make any decisions regarding a group health insurance plan, contact your state department of insurance. They keep detailed records of patient complaints. If the plan you are evaluating has had a lot of complaints filed against it by patients, it is best to avoid purchasing group health insurance through that company.