MULTI-CARRIER VS SINGLE CARRIER PROGRAMS

The upside in multi-carrier group medical programs is usually their unequaled flexibility in choice of plans. The downside is perhaps their unequaled flexibility in choice of plans.  (Employees are faced with a wilderness of options that require much careful, patient explanation)

Multi-carrier plans essentially transfer all of the purchase decision-making to members and allow the employer to merely fix a cost level.  Instead of a single insurer, coverage may be provided by several different carriers, although the programs go to great lengths to appear seamless.

In response to the success of multi-carrier plans, individual carriers have moved to also offer two or more options of their own. Aside from cost, your choice of what to offer should be driven by the differences in wants and needs among the group members, along with your tolerance for dealing with more complicated plan servicing.  If you can make this decision early on, there is usually far less to sort through.  Here is where your broker should put up the alternatives in a well-organized, concise manner.

RATES - THE "R.A.F."

Single-carrier quotes are usually given as "Standard" rates. A surcharge or a credit applies upon enrollment of your group,   (the "Risk Adjustment Factor", supposedly to account for the individual medical and other characteristics of your particular group. ). Therefore, your actual monthly cost is only fixed after you have applied.   

COMPARISONS

Much of the utter bewilderment in medical plans is simply in the endless variations and options. The most basic benchmarks suitable for ranking plans (by cost) are:

1) Per-doctor-visit copayment

2) Calendar Year Deductible and Annual out-of-pocket maximum.

3) Hospital Deductible and/or copayment and co-insurance percentage.

4) General Plan Coinsurance In/Out of network

Plans are often labeled (Titled) by one of these items. Your broker should organize things into a concise, meaningful display.

PROVIDER NETWORKS

Although market pressures have tended to swell the numbers, the listings of contracted doctors in any given plan change constantly.   Carriers still publish written listings, however these things are usually inaccurate on the day they're printed.  The online listings are usually far more reliable, although it is important to realize doctors can bail from their contract at any time as long as they comply with its notice provisions.

The most bitter complaints about claim rejections & reductions come from people who obtained pre-approval for procedures, checked doctor listings, only to find later that unlisted specialists had been also used. (Often anesthesiologists) In these instances, net costs to the patient can be shocking.

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