If benefits are similar, how do you choose the right health plan?

Published: April 1, 2019

Written by Garry Maisel  – President and CEO, Western Health Advantage

Choosing a health plan for your employees is a big decision. How do you decide when it seems that all the health plans are offering the same benefits? Under the Affordable Care Act (ACA), implemented in 2013, standardized plan levels were established and many preventive care services became covered by all plans when done in network. So how should a business owner or human resources representative decide between them?

I’ve thought a lot about this as the CEO of Western Health Advantage, which operates in the Sacramento region and Bay Area in partnership with local providers like Dignity Health and Canopy Health. The answer is to look for a health plan with the following traits.

Reputation matters

A health plan’s reputation should be your No. 1 consideration when choosing a health plan. If you work with a good broker, he or she should know the reputation of the insurance companies in your area and whether or not there have been significant customer service issues with any of them. You don’t want to choose a plan that’s difficult to work with.

Find out specifically about the health plan’s customer service. Is the plan’s customer service department known for being easy to work with, professional, and courteous? Do they resolve issues with a fast turnaround, or are callers put on hold for hours? You and your employees will want to be able to call the plan and get answers quickly.

Choose local

Does the health plan make decisions locally, without delay? Can they be reached quickly in person or on the phone? And does the health plan care about their community? The best health plans affect positive change in their communities through charitable outreach and volunteer efforts.

The plan must provide good value

Price is almost always the primary concern for business owners, so naturally you should look for a health plan that fits your budget. I’m not saying choose the cheapest plan, no matter what. Find one that, taking into account all of your particular considerations, gives the best value for your money. A good health plan should be able to provide quality health care to members while still managing costs efficiently.

The plan’s network must meet your employees’ needs

Does the plan offer a network with lots of local health providers in your area, including local hospitals and medical centers? If you are looking at HMOs and PPOs, the two primary types of managed health programs for employees, look for the best of both worlds, if you can – an HMO that gives you options similar to a PPO. Not all HMOs are the same. If you decide on an HMO, find one that allows you flexibility by virtue of having multiple medical groups. Then you’ll have choices such as allowing different PCPs for employees and their covered family members, allowing PCP changes at any time, and specialty referral programs that let you choose your specialist.

Health care is relationship-driven

The health care industry is built on relationships. As mentioned, a health plan’s customer service should interact positively with their members. The health plan should also respect the relationship between patients and doctors without interference. And their sales and plan management staff should be easy to work with, with open lines of communication from which you can build a strong relationship.

It’s a matter of trust

With the right health plan, you’ll know that your employees are going to be taken care of, that they’re going to have quality doctors and quality health care. A solid health plan’s core values don’t change; they interact honestly with their partners, while building relationship based on trust.

So when it’s time to renew or choose your organization’s health coverage, my advice is to ask around and find out which health plan in your area has these traits that go beyond the basic coverage offered.

Learn more about health plans for your business offered by Western Health Advantage.

Headquartered in Sacramento, Western Health Advantage is a nonprofit HMO health plan founded in 1996 with a community-based mission by doctors and health care providers.  WHA serves 14 Northern California counties (Sacramento, El Dorado, Placer, Yolo, Colusa, Solano, Napa, Sonoma, Marin, San Francisco, San Mateo, Alameda, Contra Costa and Santa Clara).

Published in the Sacramento Business Journal on April 1st, 2019