Selecting a Group Health Plan

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Whether you are exploring group health plans or looking for an alternative to your current provider, there are several considerations to keep in mind. These considerations are legal and financial, as well as coverage. Most group health plan providers will offer similar coverage, but with many small differences in coverage and exclusions.

Legal

Most individual or group plans will be compliant with Affordable Care Act (ACA) requirements, but this should not be assumed. Check the plan’s site to be sure. This may require some digging into their legal and financial disclosures. The financial aspects of the plan may take some more evaluation.

Financial

The most important single consideration is the premium cost if they are covering all or part of it. Find out how much the plan costs in any case because the next step in the health plan evaluation is to consider the coverage of the plan in terms of medical procedures, payments, and so on. Group health plan providers have different plans with different copays and deductibles.

Coverage

The deductible and co-pay costs are important, but so are the relevant medical procedures. The co-pays for prescription drugs are also important. Make sure most or all prescription medicines are covered, which may not be true.

Evaluating a group health plan that provides decent coverage at reasonable rates is not too difficult. Employers just need to evaluate some legal, financial, and coverage issues then compare how various options rate on the important factors.