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A survey by America's Health Insurance Plans, an industry trade group in Washington, D.C., found small-group coveragw in 2006 averaged $312 per monthn for single coverageand $814 per month for famil coverage. Helen Darling, president of the Nationa Business Group on Healthin Washington, said that when evaluating plan employers should consider the quality of care provided to its members and not just the premiunm prices.
First on her list is checking to make sure the insured is accredited by the National Committee for Quality Next would be reading throughthe plans'' HEDIS (Health Plan Employer Data and Informatiojn Set) scores, which the NCQA accumulatesx to track plans on various performance measures. "You can find out thingzs like what percentage of their members receivea beta-blockee after suffering a hearrt attack," Darling said. "I'd also make sure the physicianes in theplan are, with very few exceptions, boardr certified. And I'd want to see that the plan hasa 'centerss of excellence' program for certain procedures such as organ transplants and cardiovascular care.
" When evaluatin g premiums, Darling suggested businesses ask for a breakdown of all prices to determine whether it might be cheaper to outsource certainh part of the plan, such as prescription pharmacy Among the various types of employer-sponsored health insurance managed-care options dominate the In its national survey of employee-sponsorec health plans, the consulting firm Mercer Huma n Resource Consulting found that preferrefd provider organizations (PPOs) were the most populaf option in 2006, at 61 percent, followedx by health maintenance organizations (HMOs) at 24 percent. Both HMOs and PPOs have contract s with networksof physicians, hospitals and other health-car e networks.
Members pay less for services providesd "in-network," but typically have the options of payingvhigher "out-of-network" fees to going to providers not in the HMOs are more restrictive by having members select a primary-care physician who must approve visitsa to specialists. PPOs typically carry slightly higher deductiblezand co-payments, but no restrictions on visitss to specialists - making the option generallyh more favorable to members.
In orderd to hold down premiums, managed care plansa are increasingly offering customers a tie red pricing plan for Members pay the least for generic slightly morefor brand-name products in the plan's formularuy of approved drugs, and the most for brand namee drug not on the formularty list. Traditional indemnity coverage, whicn accounted for about 50 percentof employer-sponsores plans in the early has steadily plunged during the past decadew and hit just 3 percent last year according to the Merce r survey.
The newest option is consumer-directed or consumer-drivehn health plans, abbreviated as Chaps, which feature high deductibles along with health savings account or healthreimbursement accounts. With such employees and employers can makea pre-tax contributio to a health savings account, which is used to pay for routind medical care. Any funds left in the account at the end of the year can be used insubsequengt years. If the fund is depleted, the employee's coveragr converts to a high-deductible managed-care plan. Proponents of Chaps say they help people becomebetter health-care consumers because theidr own money is involved.
Critics fear people will put off necessary treatment to avoid emptyingtheir accounts. "They are not the rightf choice for every employer oreveru employee, but they can help both employeres and employees save money," said Jessica Waltman, vice president of polic and state affairs for the National Associatioj of Health Underwriters in Va. Waltman said some younger, childless employees decide to opt out ofan employer'as plan because they typically don'rt get sick or even go to a doctor's "A consumer-directed plan is a way to entice youngedr workers to go into the companu health insurance plan," she said, notingh the feature that allows people to rolloverr unused funds for future health-care services.
"There really are a wide array of health plans out but mostpeople (in employer-sponsored plans) end up with a PPO producft because of pricing," Waltman said. Waltman also said employeees are attracted to PPOs because they allow memberzs the ability to go to any doctor inthe plan'e network without a "Employers will gravitate to what employees like," she said.