By Ron Goldstein
Debates on universal health care continue to dominate headlines across the nation – and are likely to continue throughout 2019 and 2020. As politicians from both sides of the political spectrum weigh in and dive more deeply into the pluses and minuses of universal coverage, health care exchanges are likely to gain more visibility as a strong alternative.
Think of an exchange as a health care marketplace. Well-designed exchanges can benefit both employers and employees by giving them the freedom to choose which insurance carrier best suits their needs. Additionally, the brokers who represent these exchanges are not forced to serve up a one-size-fits-all option.
For example, a 20-something unmarried employee just entering the workforce will likely want a different health plan than a mid-50s sales manager with a spouse, three children and plans to retire in the next decade. Private exchanges allow brokers to offer a variety of health care plans and meet varying employee needs.
Private exchanges provide many benefits to brokers, employers and employees. Here are 10 features that make private exchanges a great option for all:
- Employee choice: Employers and their employees have access to leading national, regional and local health plans and dozens of coverage options. This makes it is easy to find a plan that can address each employee’s individual or family health care needs. One employee who rarely visits the doctor may prefer an HMO because of its limited out-of-pocket costs and lower cost overall. Another may be drawn to an Exclusive Provider Organization (EPO) plan because it includes a specific health care provider. A third may like the flexibility offered by a PPO, while another prefers a High Deductible Health Plan paired with a Health Savings Account (HSA). An exchange delivers options for all employees. If a business owner wants to change plans at renewal, he or she can remain in most private exchange programs year-after-year.
- Cost control: Many small group employers can attest to the fact that they want to have complete control over their operational and benefits costs. The good news is that private exchanges give employers the power to decide how much to spend on employees’ benefits, with a fixed dollar or fixed percentage contribution to the overall premium. In addition, that amount is locked-in for 12 months. If an employee selects a plan that costs more than his or her employer’s contribution, the employee simply pays the premium difference.
- One single bill: In the past, employers would receive individual bills from each carrier for their employees’ health insurance coverage. For small group business owners with more than 20 employees insured by multiple health plans, this was a nightmare. Having separate bills from each carrier created monthly paperwork that could be confusing and time-consuming to sift through. Now, when employers choose coverage through an exchange, they can receive one bill for all employees even if they choose different health plans from different insurers. Ultimately, this process is much more streamlined and eliminates unnecessary piles of paper.
- Automated tools: Today’s workplaces can feature as many as five different generations of workers, each with his or her own health and wellness needs, wants and specific budget requirements. Automated tools, such as choice profilers, give brokers and their clients the power to easily compare health plans – not just based on premium but on doctor availability, quality, affordability and how employees expect to use their plan.
- Provider search: One of the top questions employers have about health care is “can my employees keep their doctors?” The good news is that, typically, provider searches are built into private exchanges to help brokers and their small group clients identify health plans associated with employees’ preferred doctors. It is easy to confirm hospital and network affiliations, medical groups and other critical information that influence the personal decision-making process.
- Rx directory: Access to prescription drugs is one of the most important features of a health insurance plan. Allowing employees to price their monthly and/or annual costs of generic and brand name medications is just as important. An online Rx search directory provides the solution that meets both of these needs. It helps ensure the plans under consideration include coverage for employees’ necessary prescriptions and, ultimately, delivers health care that best meets the needs of every member of the employer’s team and their families.
- Ancillary benefits bundling: Historically, employer-sponsored health insurance has focused specifically on standard medical care such as doctor visits, prescription medications and occasional trips to the emergency room. However, today, there are opportunities for brokers to enhance health plan packages with additional services at affordable rates that involve minimal employer investment. This means bundling benefit packages to offer voluntary options for dental, vision, life insurance and other ancillary coverage, while staying within an employer’s budget. Ancillary products can often be added as a voluntary-only option.
- Online enrollment: Small group enrollments no longer require brokers and their clients to fill out a pile of enrollment forms by hand. Now, this process is increasingly available online, with many brokers embracing going paperless. It helps eliminate incomplete applications and dramatically speeds up processing time, while also allowing for a more positive enrollment experience for broker and clients alike.
- Access to health and fitness products and services: An increasing number of workplaces are embracing wellness by offering employees access to gym memberships, weight-loss programs and other lifestyle enhancing offerings. Employers who purchase health insurance through private exchanges can often meet this need and provide employees with discounts to health and wellness programs and services, including fitness trackers, fitness gear, vitamins, juicers, cookbooks, baby monitors, strollers and more.
- Customized benefits: Access to added benefits is another unique feature of private exchanges. These can include employee discounts on shopping, entertainment and regional attractions. Employers also enjoy customized benefits such as payroll and 401(k) integration. Brokers can provide increased value to small group employer clients by incorporating these perks into their clients’ employee benefit plans.
Benefits professionals with access to private exchanges offer the most comprehensive service to small group employers by providing them with valuable information on traditional health insurance as well as optional add-on services. Multicarrier exchanges will continue to provide an increasing number of small group employers with the cost control they want and the customized benefit plan designs employees have come to expect.
Ron Goldstein, CLU, is president and CEO of CHOICE Administrators®, which provides health insurance options and provider access to small businesses and their employees. He also created and currently manages America’s longest-standing, state-approved exchange, CaliforniaChoice. For additional information, please visit http://www.mycalchoice.com/.