If you check out any HR news at all, you will notice that the new healthcare rules are frequently cussed and discussed. The new goals for health coverage create difficulty for employers because there are a lot of unknowns for them.
A new development in employer health benefit programs is a “tiered’ system for premiums. This new system has become more prevalent, according to an article in the Society For Human Resource Management News, because of the new regulation concerning coverage of adult children. Employers are trying to find ways to share the increased cost of providing coverage for employees’ adult children up to age 26.
The tiered system usually breaks down into these categories: Employee only (individual), employee plus spouse (or increasingly plus one, either spouse, partner or child), Employee plus children (without spouse/partner), or Employee plus spouse/partner and children (family). Each level may require a different level of cost sharing with employee. In some cases the plans may limit the number of children eligible for coverage.
There is another interesting factor that companies are using to mitigate their healthcare insurance expenses – focusing on the employee’s eligibility for coverage under a spouse’s plan. Some companies deny coverage to spouses that have insurance through another source. In some cases the employee may be charged a “surcharge” if they are eligible for coverage from another source.
Pricing of coverage is very important in the overall picture. If the company’s policy is inexpensive relative to the employee’s spouse’s plan, then the employer may end up covering more dependants than other companies in the area. If the pricing is too restrictive, then employees may not get the coverage they need for their families, The end result may be a hardship for that employee in the event of a health issue, or the employee may search for other employment due to this dissatisfier.
Now let’s throw another factor into the mix. In a blog in the New York Times online recently, the blogger posted the idea that American insurance companies may go away altogether. There are a couple of reasons given: first , over 60% of working Americans are now covered by a company self-insurance plan. Second, the new healthcare reform act, focusing on accountable care organizations, may significantly affect the reimbursement process for care. The outcome may be that providers are reimbursed by patient, with bonuses for quality achievements. Theoretically the providers will be focused on keeping the patient healthy to keep treatment costs down. Also there’s no need for an insurance “gatekeeper”, as the company or group of individuals will contract directly with the provider group for care. (Sounds a lot like the original HMO plan goals, without the insurer. We’ll see!).
So, best of luck to employer and employee alike!
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