Health

22 HEALTH • June 15, 2015 Some tactics for limiting health insurance costs F or years, rising health care costs have challenged both employers and employees. The trend is particularly difficult in 2015 because of the Affordable Care Act, with all its nuances, and the significantly altered portfolio of products insurance com- panies now offer. Working with small and medium sized businesses across Central Massachusetts, we have identified sev- eral tactics that can be applied to limit the impact of premium increases on a company's bottom-line and on their employee's paychecks. It's a balancing act to manage costs while still provid- ing a quality benefits program for employees. Fundamental to the approach are transparency and education. Both employees and business owners need to understand the elements of the new insurance products. Consumer- driven health plans are the new para- digm, which means that people see what their medical services really cost, and have some choice on what they want to pay and the level of out-of- pocket expense they are willing to tol- erate for reduced monthly premiums. Before renewal time arrives again, it's important to evaluate all the options and bring employees into the discussion and consider: Increasing Plan Deductibles and/or Co-Payments Higher deductible plans, typically $2,000 for individuals and $4,000 for families per year, can reduce the monthly premium. This means employees pay for most services out- of-pocket until the deductible is reached. For healthy people, higher deductibles and lower monthly premi- ums can yield savings, while providing a backstop of insurance for a major ill- ness or trauma. For people with complicated or chronic conditions that require fre- quent medical services and multiple prescription drugs, higher deductible plans are more costly. In some cases, the impact of high-deductible plans can be mitigated with pre-tax pro- grams for health spending or employ- er contributions to health reimburse- ment accounts (HRAs). Offering New Tiered Network Plans The price of medical services can vary widely among hospitals and healthcare providers. A tiered plan gives employees choices of where to access care. A person can choose to go to a qualified but lower-cost facility, like a clinic or community hospital. Or they can opt to go to a higher-cost provider if that is the best choice for their circumstances. With employees paying more in premium-share and out-of-pocket expenses, the theory is they will make more consumer-driven choices and seek value, which will eventually help lower costs. Limited Network Options Rather than offering a range of pro- viders as described above, health plans can be limited to a specific network of doctors, hospitals and other providers. These limited plans offer comprehen- sive health care services, from primary care to complex medical specialties, but the plan participants must get care within the prescribed network. These limited network plans help control costs for both the employer and the employee. Beyond these considerations of plan design and costs, insurers are begin- ning to offer incentives that reward employees who meet certain health guidelines and the state has intro- duced a new Wellness Tax Credit as an incentive designed for businesses with fewer than 200 employees. Credits are awarded for businesses that invest in wellness and safety initiatives. Managing health insurance costs is complex. Using these tactics, and edu- cating employees on coverage changes, are important steps for any employer. Vanessa H. Costa is a principal at Advantage Benefits Group in Worcester. BENEFITS AMINISTRATION By Vanessa H. Costa Residential Options Adults with Disabilities or Brain Injury Seven Hills NeuroCare's Residential Options support adults with disabilities and/or brain injury in dignified, community residential homes, and in various shared living arrangements. Seven Hills' trained professionals coordinate and manage the person-centered supports, enabling community access that maximizes independence, autonomy, and choice. n Adult Family Care n Shared Living n Group Homes n Individual Supports Providing the highest quality care and a place to call home is the hallmark of service at Seven Hills—call 508.983.1323 or visit www.sevenhills.org. 81 Hope Avenue, Worcester, MA 01603 • 508.983.1323 • www.sevenhills.org Seve n Hil ls Total Local Care Is Also TOP Local Care Harrington Named One of Nation's Top Hospitals for the Second Year in a Row! The dedicated staff at Harrington is proud to make patients, quality, and safety our top priority. www.harringtonhospital.org

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