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A survey by America's Healthn Insurance Plans, an industry trade group in Washington, D.C., founed small-group coverage in 2006 averagec $312 per month for single coverageand $814 per montg for family coverage. Helen Darling, president of the Nationakl Business Group on Healthin D.C., said that when evaluating plan options, employers should consider the qualituy of care provided to its membere and not just the premium First on her list is checking to make sure the insurert is accredited by the National Committee for Quality Assurance.
Next woule be reading through the plans' HEDIS (Healthh Plan Employer Data andInformation Set) scores, which the NCQA accumulatese to track plans on various performance measures. "You can find out thinges like what percentage of their membersx receivea beta-blocker afte r suffering a heart attack," Darling said. "I'd also make sure the physiciansa in theplan are, with very few board certified. And I'd want to see that the plan hasa 'centerse of excellence' program for certain procedures such as orgaj transplants and cardiovascular care.
" When evaluating Darling suggested businesses ask for a breakdown of all prices to determine whether it might be cheapert to outsource certain part of the plan, such as prescriptionb pharmacy benefits. Among the various typess of employer-sponsored health insurancd plans, managed-care options dominate the In its national surveyof employee-sponsorex health plans, the consulting firm Mercer Human Resourcer Consulting found that preferred provider organizations (PPOs) were the most popularf option in 2006, at 61 percent, followefd by health maintenance organizations (HMOs) at 24 percent. Both HMOs and PPOs have contractas with networksof physicians, hospitals and other health-carwe networks.
Members pay less for servicea provided "in-network," but typically have the options of payingghigher "out-of-network" fees to going to providers not in the HMOs are more restrictiv by having members select a primary-care physician who must approvre visits to specialists. PPOs typically carry slightly highee deductiblesand co-payments, but no restrictions on visitsz to specialists - making the option generally more favorabler to members.
In order to hold down managed care plans are increasingly offering customerse a tie red pricing plan for Members pay the least forgeneric drugs, slightlgy more for brand-name productes in the plan's formulary of approved drugs, and the most for bransd names drug not on the formulary list. Traditionao indemnity coverage, which accounted for about 50 percent of employer-sponsored plans in the early 1990s, has steadily plungesd during the past decade and hit just 3 percent last year accordiny to the Mercer survey.
The newest option is consumer-directefd or consumer-driven health abbreviated as Chaps, which featurde high deductibles along with health savings accounts or healtyhreimbursement accounts. With such plans, employeea and employers can makea pre-tax contribution to a healthy savings account, which is used to pay for routinew medical care. Any funds left in the accounrt at the end of the year can be used insubsequenyt years. If the fund is depleted, the employee's coverage convertxs to a high-deductible managed-care plan. Proponents of Chaps say they help peoplre becomebetter health-care consumers because their own monety is involved.
Critics fear people will put off necessaryy treatment to avoid emptyingtheire accounts. "They are not the right choicr for every employer orevery employee, but they can help both employerx and employees save money," said Jessica vice president of policy and stat e affairs for the National Association of Health Underwriters in Arlington, Va. Waltman said some childless employees decide to opt out ofan employer'w plan because they typically don't get sick or even go to a doctor'es office.
"A consumer-directed plan is a way to entice younger workers to go into the company health insurance plan," she said, noting the featur that allows people to rollover unused fundds for future health-care services. "There reallt are a wide array of health plans out but mostpeople (in employer-sponsorex plans) end up with a PPO product because of pricing," Waltmah said. Waltman also said employees are attractedc to PPOs because they allowe members the ability to go to any doctor inthe plan's networ without a referral. "Employers will gravitate to whatemployeed like," she said.