| Every business needs capital to survive, but an | | | | benefit to the employee is that the per-visit or |
| even more important need is that of people to | | | | annual deductibles are usually lower than with |
| run a business and keep it growing. | | | | other plans. |
| For companies in Texas and especially high | | | | In a Preferred Provider Plan, also known as PPOs, |
| growth areas like Dallas, Houston and Austin, any | | | | the health insurance company has negotiated price |
| problems that exist now are likely to increase. | | | | discounts with health care providers and, if those |
| The reason? An aging workforce and a projected | | | | services are used, they are reimbursed at a |
| high percentage of people moving to Texas will | | | | higher percentage than if the patient goes |
| mean more demand for workers. With classic | | | | elsewhere. One difference is that PPO members |
| supply and demand rules, that is likely to mean | | | | can see doctors without first getting a referral. |
| competition. | | | | They can also use doctors outside the network if |
| Employers who want to win the race for workers | | | | they are willing to pay a higher fee. |
| are looking at all the tools available to them, | | | | For an employee using a PPO, however, the cost |
| including benefits. With a high percentage of | | | | is generally somewhat higher, even for doctors |
| workers in Texas currently without health | | | | within the network. |
| insurance (the Lone Star State has the highest in | | | | Under a Fee for Service plan, also known as |
| the nation at more than 24%), small business | | | | indemnity plans, employees can choose their own |
| owners (those with fewer than 10 employees) | | | | health care providers, giving them a wider range |
| have a challenge ahead. | | | | of options. The plans tend to be the most costly, |
| Still, many small businesses, even without the | | | | however, largely due to the fact that members |
| resources to offer group health insurance | | | | do not have the incentive to use lower-cost |
| coverage, are discovering workable options, | | | | providers. Some insurance companies counter that |
| among them membership in small group health | | | | by imposing low maximum benefits and/or fee |
| insurance plans for as few as two employees. | | | | schedules. |
| The questions many employees will be asking are | | | | Employers owe it to themselves to take the time |
| how much will the plan cost and how much of the | | | | to select not only the right group health plan but |
| premium will be paid for by the business. For | | | | also the right insurance carrier as well. Service is |
| many businesses, at least a portion of the plan is | | | | likely to be a factor that impacts the employees' |
| paid for by the company. Increasingly, however, | | | | satisfaction, and these are the very people a |
| employees are being asked to pay a higher | | | | business owner is trying to attract and retain. |
| percentage of the cost, and sometimes for less | | | | Experts suggest looking for an insurance company |
| coverage. | | | | with a good network of health care providers, |
| Clearly, the decision of how much a business will | | | | timely claims service, and relatively stable |
| pay is up to the owner or manager. However, in | | | | premiums. Wise employers will also tap into their |
| an environment where skilled and experienced | | | | own network of fellow business owners. |
| workers are at a premium, health care coverage | | | | Employers can take other steps to make sure |
| could become the one factor that has an | | | | they are doing all they can to attract and retain |
| employee choosing one job offer over another. | | | | employees who care about health insurance. A |
| While there are numerous options available to | | | | good first step would be to survey employees as |
| businesses, the choices come down to three basic | | | | to what they need or want when it comes to |
| types of health insurance plans -- managed care, | | | | health insurance. Once those needs are clear, a |
| preferred provider, and fee-for-service. | | | | business owner could work with a health insurance |
| Under managed care, the health insurance | | | | company to design a plan that includes employee |
| company has entered into agreements with | | | | contributions towards cost and keeps employees |
| certain providers -- doctors, hospitals, and others | | | | informed of health care costs and rate changes. |
| -- to offer a range of services to members at a | | | | On an ongoing basis, employers can take a role in |
| reduced cost. These plans are known as Health | | | | helping to educate employees about healthy |
| Maintenance Organizations (HMOs) and also as | | | | lifestyles and how to reduce the overall cost of |
| Individual Practice Association (IPA) or Point of | | | | health insurance. That might include communicating |
| Service (POS) plans. | | | | with employees about the specifics of the health |
| The financial benefit to consumers is that most | | | | insurance plan, the emphasis being on what is, and |
| HMOs minimize the out-of-pocket expenses paid | | | | what is not, covered. |
| for medical care, as long as the employee uses | | | | Employers can also encourage employees to |
| the plan's own doctors and facilities. Go outside of | | | | avoid high-risk activities such as smoking and can |
| the network and patients might end up paying the | | | | also promote the moderate use of alcohol and |
| entire bill. | | | | establish a zero tolerance drug and alcohol abuse |
| Members are also required to choose a primary | | | | policy. Other workplace initiatives include offering |
| care physician, and see that person first | | | | healthy choices in vending machines and |
| whenever they need medical attention, with the | | | | alternatives to pizza and beer at employee |
| doctor then making the necessary referrals to | | | | events. |
| specialists (who are also under the HMO). Another | | | | |