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Plan Design
Their
approach….
So many employers are stuck in the “perception” of the simplicity
of traditional co-pay PPO plans. Are they really simple?
- Deductibles, In & out of
network.
- Co-insurance, In & Out of
network.
- Co-pays for office visits, does
it cover testing or not? Is it a specialist?
- Three & four tiered prescription
drug co-pays. Is it a generic, a brand name, non formulary
and who makes these determinations? By the time you get
it down they change the formulary or the doctor puts
you on a new medicine.
Our approach….
Our custom designed defined contribution plans are SIMPLE. If it is a
covered cost it counts toward the total out of pocket maximum. PERIOD!!
The employee knows what their out of pocket maximum is.
- Maximum premium savings with
limited claims exposure.
- Funding of deductible via HRA,
HSA or combination of.
- Utilization of tax saving vehicles – section
125.
- Third party administration.
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here to learn more
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As Defined Benefits continue to be substituted
with Defined Contributions an employer is faced with new opportunities
and new challenges. We want to ensure that you have the expertise
at your fingertips to meet these opportunities and challenges.
From a global perspective one can appreciate
premium savings – dollars freed up to be used for wellness,
tangential benefits like dental or long-term care all while providing
more to your bottom line. The challenge lies in understanding the
myriad of options available to you and how comfortable you are
with sharing or r elinquishing
the management of such benefits. We do think that there is an opportunity
to turn a cost center into a vehicle that increases worker productivity
and their overall health and wellbeing. A shift in the marketplace
away from defined benefits to defined contributions should not
be viewed as a simple cost cutting measure. Anyone can cut costs.
Our goal is to increase the overall benefit package if possible
with an emphasis on driving down risk factors via a wellness program
that focuses on ROI…not just from the perspective of numbers,
but from the overall health improvement of the employee population.
This emphasis places benefits squarely in the center of attracting
and retaining a thriving – able bodied work force.
The defined benefit approach – for all
of its selling points – especially from the perspective of
the employee – ultimately did very little to rein in costs.
Something as simple as a co-pay, although often requested by employers
and employees alike can be a very destructive force in meeting
everyone’s stated goal of cost containment, individual accountability
and overall employee health. Co-pays have led us all to a path
of complete ignorance underlying costs associated with a doctor
visit. It not only encourages overutilization – but breeds
a more destructive force – one that drives down the perceived
value associated with a visit to the doctor, ER or hospital. Raymond
J. Keating, chief economist for the Small Business Survival Committee,
argues that the problem stems from the fact that Americans are
essentially over-insured to a large extent because 3rd party payers
shield consumers from the real cost of doing business:
“When a third party-whether an employer-provided
health plan or the government-picks up the tab for reasonable
and predictable health care spending, demand is driven up, and
consumers and health care providers possess few, if any, incentives
to be concerned about costs.”
The attraction with the defined contribution
approach usually starts with increased flexibility that allows
the Employer to respond more appropriately to the diverse needs
of its employee population and oftentimes with less employer management(depending
on size of group and plan design election). Or it may equate to
greater employer control and predictability of health care costs – depending
on the model you may incorporate. It does however ask for more
employee accountability which may take some adjustment, but those
who have adopted a consumer driven approach appreciate the increased
choice and savings many consumer driven – employer provided
plans bring to the table. If your organization wants a
more traditional approach – our team of experts can easily
assist you – with the added value of providing a game plan
for the future and guidance on how to get your organization to
the next level.
It will require greater communication.
We will have the resources available to assist with administrative
support, due diligence, employee education and wellness.
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