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Educating Clients on How Group Health and Other Benefits Can Reduce Costs for Their Businesses and Employees, Too

October 31, 2022   |   by Alex Strautman
How group health care plans reduce insurance costs

Your employer clients may not realize all the ways they’re helping their employees by offering employee benefits, including wellness programs and health insurance.

It’s obvious that health insurance offers important financial protection to employees if they or an insured family has a serious accident or unexpected sickness. According to HeathCare.gov, fixing a broken leg can cost up to $7,500. The average cost of a three-day hospital stay is around $30,000. Comprehensive care for a serious condition like cancer can run up into hundreds of thousands of dollars.

These costs can be devastating – but having health insurance through an employer can substantially reduce the share of the costs that employees have to pay for care.

Lower Costs for Covered Services

Insured employees and dependents typically pay less for care because they have insurance, as compared to those without insurance. That’s because of their health plans’ preferred provider networks offering pre-negotiated and discounted rates for covered services.

Those with health insurance can also take advantage of preventive health care services mandated in health plans by the Affordable Care Act. Depending on the insured person’s age, they may have access to no-cost preventive services including blood pressure, diabetes, and cholesterol tests; cancer screenings, including mammograms and colonoscopies; counseling related to quitting smoking, losing weight, eating healthfully, and more; well-baby and well-child visits; vaccinations; and more.

The employees and dependents may also benefit from reduced costs for care after meeting their plan deductibles, depending on the coverage offered by the employer. For example, if a plan has a $1,000 deductible, the employee pays the first $1,000 in covered services. However, depending on the metal tier for the plan, the after-deductible costs for the employee may be as little as 10% coinsurance.

In addition, if an employee’s plan has a $3,000 out-of-pocket maximum for deductibles, coinsurance, and copayments, that will be the most the employee will have to pay no matter how much covered care they receive during the rest of their medical plan year. Without insurance, there would likely be no cap on their out-of-pocket costs.

Lower Premiums

The premiums that employees pay for coverage through an employer-sponsored plan are typically less than what they might pay on their own for Individual & Family Plan coverage. Plus, the employer-sponsored coverage premium is being shared by the employer.

KFF found in its analysis of premiums that employer-sponsored family health coverage reached $22,221 in 2021, with workers paying $5,969 toward the cost. That’s nearly 27% of the cost, as compared to 100% if employees were buying coverage on their own. For single coverage, the average annual premium in 2021 was $7,739, with employees contributing $1,299 (about 17%).

In the KFF employer health benefit survey, some employees were paying even less. Twenty-nine percent of covered workers are employed by small firms and are enrolled in a plan where the employer pays the entire premium for single coverage.

Better Choices, Better Health

The Centers for Disease Control and Prevention (CDC) say that unhealthy behaviors are responsible for approximately 70% of all deaths and up to 75% of all health care costs. By providing employees with wellness benefits and other programs, employers can help employees and their dependents make better health choices. That will limit future health care costs, while also helping the employer control future insurance costs, too.

Many of Word & Brown’s health plan partners include the ChooseHealthy® program as part of their health care benefits. ChooseHealthy features the Active&Fit DirectTM program with discounted memberships at 11,000+ fitness centers nationwide, 7,600 digital workout videos, discounts and free shipping on popular health and fitness brands, and more. Participating health plans include Aetna, CaliforniaChoice, Health Net, Kaiser Permanente, and Sharp Health Plan.

Other plans offer their own programs like Healthy Living from Anthem Blue Cross, Wellvolution from Blue Shield of California, and, in Nevada, Go365 Wellness from Prominence Health Plan.

When considering plans for your clients, be sure to look at and discuss not just the plan premium (and how it be split among the employer and employee), but the provider networks, and any value-added programs that might be available. If you’re unsure about who offers what, talk with your Word & Brown representative.

If you are not working with us yet, contact our nearest office to learn more. Or, register using our online form.

 

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