VS SINGLE CARRIER PROGRAMS
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,
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.
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.
- THE "R.A.F."
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.
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:
Calendar Year Deductible and Annual out-of-pocket maximum.
Hospital Deductible and/or copayment and co-insurance percentage.
General Plan Coinsurance In/Out of network
are often labeled (Titled) by one of these items. Your broker should
organize things into a concise, meaningful display.
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.
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.