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3 “Gotchas” When Picking Health Plans for Your Team


It’s health benefits renewal season and you may be wondering what other group health benefits plans are out there besides traditional insurance. If you’re like most leaders, you want to provide quality employee benefits. But, if you’re also like most organizations, you have a really limited budget for benefits. 

Finding the best product for the lowest price can seem like a lose-lose game. You can quickly get lost in the shuffle of side-by-side comparison sheets. In the end, it almost always feels like you spend more than you want and receive less than you’d hoped. 

I have some good news for you: you don’t have to settle for this outcome! By avoiding the industry “gotchas,” you can find better health benefits for a lower cost.

Here are the top 3 “gotchas” when picking health plans for your team:

1. One Size Never Fits All

Healthcare is personal, therefore, health plans should be personalized. But because of how health insurance has developed over the past 60 years, many people just assume one-size-fits-all is good enough. This is almost as silly as assuming everyone at a company could be on group car insurance. No one does that. And why not? Because everyone has different cars — with different budgets and needs. The same is true with health benefits.

One of the major “gotchas” when picking health plans is thinking that you will be able to meet everyone’s needs under the same plan. Maybe if you get the ultra-triple-diamond-platinum coverage (which don’t exist, by the way) you “could” make it so everyone’s needs were covered. But the tradeoff for this top-of-the-line coverage could come at the cost of their jobs when company budgets are blown out of the water on health insurance. This is the balance employers need to find.

Allowing people to have a full spectrum of choices is the key to ensuring each employee receives an individualized plan. Maybe they could finally join their spouse’s plan, or take advantage of an exclusive tax program

Several models allow this type of flexibility when it comes to picking health plans for your team. Managed individual models started when the IRS allowed employers to provide individual wage increases instead of group health benefits. This worked for many employers, but not all. That’s why the newest managed individual model, called the Individual Coverage HRA (ICHRA), was introduced. ICHRA provides another option for employers to offer budgets to shop for all of their available plans instead of trying to pick one health plan for the whole team.

2. Over-paying, Under-using

Making the most of your budget when it comes to picking health plans for your team may feel like the bane of your existence. Generally, employers look to the metal levels of plans as a guide. We think to ourselves, “Gold has to be better than bronze, right?” But what if I told you that “better” is not always what you may think it is? 

The average gold plan is around $10,000 more per year than a Bronze, but they have about the same out-of-pocket limit. An HDHP, however, often has a much lower out-of-pocket-maximum. Plus, you’d be saving big time on the premium — which could then be contributed toward an HSA account. There are multiple HRAs you can use as add-ons to lower the bottom line, too. By doing so, you are essentially partially “self-funding” the net-exposure of the plan — becoming an investor of health benefits rather than just a spender.

Another thing employers often end up overpaying for is the plan’s networks. PPOs are often used as “shiny things” to lure you into spending more. The reality, though, is that most doctors you have access to under a PPO will also be covered by local networks. If you opt for HMOs instead, you can still (almost always) keep your exact same Primary Care at a much lower cost.  

EPOs are another great way to ditch the expensive network while still getting the access you need. If you have the right software, you can easily and securely confirm all of your team’s doctors are available in a slightly smaller, significantly cheaper, more focused network. Pour those savings into your team!

3. Thinking You’re Stuck

Maybe this has piqued your interest. If you’re like a lot of people, though, you may be thinking this sounds good for other people (but not for you). Or, maybe you currently feel stuck in your traditional health benefits plan.

If this sounds like you, I have good news: you’re not stuck! Change is always possible! There are several alternatives to outdated and overpriced traditional group plans you can switch to at any time. In fact, you can custom design a managed individual health benefit, made specially for your organization.

You’re likely aware that we are entering the Individual Marketplace’s open-enrollment season. Before the ACA, there was a lot of inconsistency between plan years. For example, some plan years would go July to July, whereas others would simply follow the calendar year. With the growing prevalence of the Marketplace, though, many carriers have transitioned their clients to follow in-tandem with it.

What many people don’t realize, though, is that you can change plans anytime — even if it’s not open enrollment! Solutions like ICHRA actually generate a Special Enrollment Period, and products like hybrid sharing alternatives can start at any time of the year, as well. So don’t believe the “gotcha” that you’re stuck in your current health benefits — you can change at any time!

Want help caring for your team?

When it comes to picking health plans for your team, don’t go it alone. You don’t have to become an expert in health insurance to pick a good plan. You can get help at any time!

Remodel Health can give you and your organization a full analysis, helping you see the full spectrum of options available out there. With the right health plan, you can care better for your team while cutting costs and regaining resources. Book a demo or email us to see how you can pick a better health plan for your team!

Important Notice:  Remodel Health does not intend to provide specific insurance, legal, or tax advice. Remodel Health always recommends to consult with your own professional representation to properly evaluate the information presented and its appropriate application to your particular situation.