{"id":785,"date":"2022-06-14T08:13:38","date_gmt":"2022-06-14T15:13:38","guid":{"rendered":"https:\/\/immixgroup.ca\/blog\/?p=785"},"modified":"2022-06-20T08:56:51","modified_gmt":"2022-06-20T15:56:51","slug":"health-benefits-quote","status":"publish","type":"post","link":"https:\/\/immixgroup.ca\/blog\/2022\/06\/14\/health-benefits-quote\/","title":{"rendered":"Check to Ensure your Benefits Quote is Actually for a Comparable Plan"},"content":{"rendered":"\t\t
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5 Key Areas to Check to Ensure your Benefits Quote is Actually for a Comparable Plan <\/h1>\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/section>\n\t\t\t\t
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Inflation is on everyone’s mind; wherever you look, prices are rising. Unfortunately, benefit plans are not exempt from this. When the cost of dentist visits, medical items and procedures goes up, the result is often higher claims. This can sometimes end up passed along to employers as a renewal rate increase<\/a>.<\/em>\u00a0<\/em><\/p>

Many of you may be considering getting a quote on your benefits plan<\/a> or may have already received quotes from alternative providers.\u00a0 Before you make a decision on moving your program, there are a few key points to check to ensure your quote is not too good to be true. <\/em><\/p>\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/section>\n\t\t\t\t

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Is it truly apples-to apples?<\/h2>

Consider this scenario: you’ve been presented with a quote for a benefits plan<\/a>. You had asked for the quote to be apples-to-apples to your current plan. The good news is the price is significantly cheaper than what you’re paying, and supposedly, the plan designs<\/a> are equal. But are they?<\/p>

In our line of work, it’s not uncommon to come across what is positioned as a comparable plan, only to find there are many details that have resulted in the lower price. They can be glossed over in a plan summary, and when the time is not taken to examine every nuance to the coverage, it can leave owners- and their employees-<\/a> disappointed. There is nothing worse than rolling out a new program only to hear from an employee that their prescription -which was always covered under the old plan- is now excluded.<\/p>

As we have written about in the past, it’s very common to get discounted pricing<\/a> from an insurer. In short, the carriers usually need to extend some level of reduced pricing in order to gain your business.<\/p>

And certainly, there are opportunities for true savings on administration costs<\/a>. \u00a0But discounts aside, and beyond the summary of the coverage, we have compiled a list of specific plan elements to check and compare.\u00a0<\/strong><\/p>

\u00a0<\/strong><\/p>

Top 5 things to Review if a Benefits Quote seems Too Good to be True<\/h2>

\u00a0<\/strong><\/p>

  1. Review the details of the Prescription Drug Plan: <\/strong><\/li><\/ol>

    What are the details of the drug plan? Is there a managed drug formulary, excluded drug categories or drug caps? Does the plan mandate generic substitution or not?<\/p>

    A drug formulary is simply a list of the drugs that are covered on the plan. Oftentimes, a drug formulary is designed to exclude certain medication categories (fertility drugs or oral contraceptives are typical examples), in order to cut costs. In some instances, a drug plan may even exclude specialty drugs, the expensive but often lifesaving\/ lifestyle saving drugs. While it’s often positioned as a benefit to employers, this could leave your employees with major uncovered drug expenses.<\/p>

    It is important to understand the implications of the drug plan. Generally speaking, a drug plan is a key part of the extended healthcare and is intended be an insurance plan. A plan that covers antibiotics (roughly $10-15) but excludes drugs for MS or Chrohn’s disease ($10K+ per year) is not providing coverage against a financially significant, often unexpected expense. While it’s true that a more open drug plan could mean higher drug claims than under a more restricted, managed formulary, the program’s stop-loss max will typically work to limit the plans exposure to high-cost drugs.<\/p>

    How the program adjudicates brand name versus generic drugs should also be clearly known; it’s standard these days to have generic substitution on a program, but this can work differently depending on the carrier or how the plan is set up (for example, will the plan allow the doctor to indicate \u2018no substitution’ and therefore cover the brand name version of a drug?). Differences in this area have cost implications.<\/p>

    Lastly, is the annual limit for prescription drugs \u2018unlimited’ or is there a dollar limit? You may be okay with implementing a capped drug plan, but again, you need to understand the details and implications. A qualified and experienced benefits advisor will be knowledgeable on all the above points, and most importantly, should be open and transparent about what you are getting.<\/p>\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/section>\n\t\t\t\t

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    1. Check the Dollar Maximums and Limits for Key Items: <\/strong><\/li><\/ol>

      You may have checked in the plan summary that the coinsurance is the same; 80% on certain lines of coverage, 100% on others. But what are the per item or category maximums?<\/p>

      \u00a0<\/p>

      The following are the most common items where benefit maximums may be listed, in the fine print:<\/p>