Broker Check

Choosing Medical Plans for Small Businesses

| October 12, 2022


       Choosing a medical plan for yourself may be easy. You may know how often you go to the doctor, and how much you may use the insurance, but this completely changes when it comes to selecting health insurance plans for your employees. What you may believe is the best insurance plan can differ from what they believe is the best plan. There are many different options when it comes to the make-up of the health plans that you can choose from.  

        One of the biggest clashes in opinion that I see is the perception of the deductible. Many think that the insurance company only pays their portion of the bill once the deductible has been reached. This can be true; it is not always the case though. It is dependent on whether your coinsurance or co-payment is followed by after deductible. And if it is followed by an after deductible, you must first pay for all your medical services out of pocket until that amount reaches your deductible. 

         Another factor that plays a significant role in selecting a plan for your company is how often the employees will use the insurance. Do your employees have children? Employees that take medication or go to the doctors for more than just preventative care may want to know the cost ahead of their doctor visit, which is a copay. They may want to make sure that services like lab work, x rays, or MRIs are covered before they reach the deductible. You may also have employees who only want the insurance as a worst-case scenario for major medical concerns, plans where the insurance only kicks in after you meet your deductible, which is usually your maximum out of pocket as well.  

        Once you finally know what plan you would like to select, you need to make sure that the doctors that your employees see are in network. Some employees may not care, but some employees may have a specialist that diagnosed their condition that they would never leave.  

        You may be asking to yourself does it matter that my employees don’t like the plans I selected? If they do not like the options presented, they can opt out of insurance. This is true, but certain companies require a minimum participation percentage from eligible employees without an eligible waiver. An eligible waiver is a waiver for an employee that has spousal or other group coverage, that makes the employee not count against the participation rate. 

        While choosing a plan may be tough, choosing the wrong plan can be terrible. That is why it’s important to get as much information as possible before choosing a plan.