A Starter Guide to Small Business Health Benefits. | hioscar Blog | Oscar
A Starter Guide to Small Business Health Benefits.
Our Starter Guide to Small Business Health Benefits offers a crash course on everything you need to know.
Employee Health BenefitsTips for Small Businesses
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It’s a big commitment to pay for and administer health benefits for your employees. But as a small business, offering group health insurance is one of the biggest advantages you have for attracting talent, employee productivity, and retention—especially in challenging times.
Navigating employee health benefits can be overwhelming. Our Starter Guide to Small Business Health Benefits offers a crash course on everything you need to know about plans and benefits when choosing a plan for your employees. Save it now for easy access, and keep reading for more.
It’s a smart tax move. Premium contributions are pre-tax, and companies with over 50 full-time employees have to pay a tax penalty for not providing health benefits.
It gives you a competitive advantage in hiring. If employees are choosing between gigs, they’re more likely to join your company over another that doesn’t offer health benefits.
It helps with retention. Employees are less likely to leave if they have great benefits.
What employees want in a health plan.
Personalization
18% of employees say that more personalized health care plans (opens in new tab) are an area for improvement. Consumers regularly receive personalized shopping and media recommendations, and they now expect the same kind of personalization in their health care experience. They want to be heard, understood, and given clear, personalized directions on what to do.
Simplicity
18% of employees are dissatisfied with an employer-sponsored plan (opens in new tab) that is too confusing. Many employees want simple, clearly explained plan information so they can make informed choices about how to use their plan.
Comprehensive coverage
39% of Americans that receive health care through their workplace site comprehensive coverage (opens in new tab) as the main factor driving their satisfaction in their current health plan. Employees want to ensure that the benefits, care, and treatment that are important to their health needs are covered.
Technology
26% of people on employer-sponsored plans are looking for online tools (opens in new tab) and apps to provide information about their insurance options. Employees want to be in control of their health care.
Mindfulness
57% of employers plan to focus on mental and behavioral (opens in new tab) health over the next three years. Employees want coverage and resources for both body and mind.
Health insurance plan basics.
Before you can make smart decisions about which insurance plans to offer, it’s important to understand a few basic elements (opens in new tab). These have the potential to impact value and costs for you and your employees.
Cost components: Insurance plans are built around a few different types of costs that directly impact health care spending for your business and employees.
Deductible: A deductible (opens in new tab) is the amount an employee will spend on covered services before their plan starts paying for care.
Premium: A premium (opens in new tab) is the monthly payment required to have an active health plan. It can be paid fully by an employee, by an employee and your business, or fully by your business.
Copay: A fixed dollar amount (opens in new tab) an employee will spend on covered service at each time they seek a service—such as a visit to an urgent care center or filling a prescription.
Out-of-pocket: Out-of-pocket expenses include any money an employee pays toward covered health care expenses, including copays and coinsurance (opens in new tab)
Out-of-pocket max: An out-of-pocket max (opens in new tab) is the maximum amount an employee will pay for health care during the year. After they meet this amount, their plan will pay for all covered medical expenses.
Health plan types.
There are several different types of health plans to get familiar with. All health plans will give employees access to a health network. A network (opens in new tab) is the group of doctors, medical groups, and labs members have access to as part of their insurance plan. Plans are designed to balance care access to networks and cost. Here are the four main types of health plans (opens in new tab):
HMOs (Health Maintenance Orgs)
Lower price and limited access to care. Small networks designed around a single medical group or hospital system. You must select a primary care doctor, and referrals are required before you go to a specialist, lab, or other medical facility. Generally, out-of-network care isn’t covered.
EPOs (Exclusive Provider Orgs)
Good price and best access to care for price. Smaller networks that combine the flexibility of a PPO with the cost savings of an HMO. You don’t need to choose a primary care doctor or ask for referrals. Care is covered by doctors and facilities in the network, but not outside of it (except in emergencies).
POSs (Point of Service)
Moderate price and broader access to care. Broad networks that fall somewhere between HMOs and PPOs. They provide lower costs when you see in-network doctors, and include coverage for out-of-network care with a referral. You must have a primary care doctor and get referrals to see a specialist, even if they’re in-network.
PPOs (Preferred Provider Orgs)
Most expensive and broadest access to care. Broad networks that typically cover care from in-network and out-of-network doctors and facilities. You don’t have to choose a primary care doctor, and referrals aren’t required to see a specialist.
Plan design basics.
Insurance plans come in a variety of shapes and sizes. How an insurance plan is designed will impact how (and how much) your business and employees pay for health care.
Traditional
Traditional plans are available from almost every insurance company. They follow a standardized metal tier structure (opens in new tab) and cost share between the employee and the insurer.*
Bronze plan: Low premium, high deductible. 60% of covered health costs paid by insurer, 40% paid by employee.
Silver plan: Moderate premium, moderate deductible. 70% of covered health costs paid by insurer, 30% paid by employee.
Gold plan: Higher premium, lower deductible. 80% of covered health costs paid by insurer, 20% paid by employee.
Platinum plan: Highest premium, lowest deductible. 90% of covered health costs paid by insurer, 10% paid by employee
HSA - compatible
HSA-compatible plans are high-deductible plans that work with a health savings account (opens in new tab) (HSA). Employees choose how much to contribute to their account and use this pre-tax money to pay for health care expenses.**
How to choose high-value, cost-effective health benefits.
Cost considerations
Premiums: The lowest-premium plans can place more of the financial burden on employees, even if they’re most affordable for your business. Consider the cost of plans for both you and your employees.
Contribution amounts: Some insurers have a minimum contribution amount for plan premiums, so make sure to ask your broker or insurance carrier about requirements.
Participation requirements: Most insurers require (opens in new tab) a certain percentage of your employees to purchase plans through them. Ask your broker or insurance carrier for details.
Doctor preferences: It’s hard to meet everyone’s needs when it comes to doctor preferences. Some people are happy to pay more for access to specific providers, while others aren’t.
Employee considerations
Personalization: Work with insurers who invest in a personalized, consumer-first experience.
Cost: Give cost-conscious employees the option to buy a more affordable plan.
Convenience: Choose plans that cover convenient care options like telemedicine, urgent care, and retail clinics.
Wellness Perks: Look for plans that provide wellness perks such as step-tracking rewards, classes, and workshops, so even healthy employees get value from their plan.
A range of options: Offer plans that cover people with varying health needs and budgets. You can offer a mix of health plans while setting the business contribution to one of the lower cost options.
Customer service: Find a plan that will help your employees navigate their benefits. Choose an insurance company with a dedicated customer service team, so your employees can get questions answered quickly.
Technology: Choose an insurance company that empowers its members with data and technology so they can better understand their health and medical costs.
Doctor Choices: Health plans with a broad network of doctors is important to some employees, while others are satisfied with a narrow list. Look for an insurance company that can offer both without complicated rules.
Whole person health: A health plan with a comprehensive mental and behavioral network to support emotional wellbeing.
Looking for group health plans? We’ve got you covered.
The Cigna + Oscar mission is devoted to providing health insurance that’s helpful and easy to understand, and provides a personalized customer service experience and benefits that feel good to use.
To learn more about our plans visit cignaoscar.com (opens in new tab), call our team directly at 1-855-672-2784, or talk to your broker about us.
*Metal tier structure varies and is subject to plan deductibles, co-payments, and coinsurance.
** Coverage is subject to plan deductibles, co-payments and coinsurance. See your plan documents for details.
Cigna + Oscar coverage is insured by Cigna Health and Life Insurance Company.
Product availability may vary by location and plan type and is subject to change. All group health insurance policies and health benefit plans contain exclusions and limitations. For costs and complete details of coverage, contact an Oscar representative. Coverage is subject to plan deductibles, co-payments and coinsurance. See your plan documents for details.
Cigna + Oscar coverage is insured by Cigna Health and Life Insurance Company. Benefits are administered by Oscar Management Corporation, an affiliate of Oscar Insurance Company. Pharmacy benefit management services are provided by Express Scripts, Inc. “Cigna” is a brand name and refers to operating subsidiaries of Cigna Corporation, including Cigna Health and Life Insurance Company and Express Scripts, Inc.
