Medical

In today’s competitive work environment, employees feel they are entitled to a wide range of company-provided fringe benefits. These typically include basic and major medical protection, prescription, vision, dental and group life insurance. A myriad of choices are available for plan design depending on the size of the company’s employee group and budget for benefits.

These choices involve a number of variables that affect premium:|

• Fully funded to self funded
• Basic benefits (medical/RX) or expanded benefits
• 50% to 100% employer paid
• Co-Pay – Coinsurance
• Deductibles
• Out of Pocket Maximums
• Closed panel or open panel/Participating and non-participating providers
• Wellness/Alternative Health Care
• Medically Necessary/Elective Procedures
• Prior Authorization/Referrals

The current trend in employee benefits is to increase the number and types of benefits available and to encourage employers to tailor benefits packages to their employees’ situations and needs. While employees expect the best in health insurance, costs are exceeding the ability of employers, providers, and health plans to buffer consumers from feeling an impact from rising costs. Surges in costs for both prescription drugs and new technologies are occurring at the same time that physicians are pushing for improvements in compensation to help offset soaring malpractice insurance costs. Managed care is facing increasing scrutiny and change from regulatory and legislative actions.

As people become more informed about the medical choices available to them, they need to become more informed about and involved in the financial consequences of their choices. Increasingly benefit plans promote greater member cost-sharing as a rational approach to support a consumer-driven health care economy. Lower premiums are available in exchange for a higher degree of cost sharing – via deductibles and coinsurance – on the part of the member.

Whether or not employees contribute to the cost of their group benefits varies from employer to employer. Generally, however, most group insurance plans begin with a modest package of affordable benefits. As employees ask for additional benefits that meet their individual situations and needs, they may be asked to assume more of the overall cost for their benefits.