BUSINESSWEEK ONLINE : NOVEMBER 13, 2000 ISSUE
BUSINESSWEEK INVESTOR Picking a Health Plan: Inertia Can Be Costly You may find that last year's choice is not your best bet You should get it this month, if it hasn't arrived already--the dreaded benefits packet. This bulging envelope signals open enrollment, the annual opportunity for you to choose among your company-sponsored medical plans. You may think the easiest thing to do is stick with the plan you picked last year. Not so fast. ''Health-care networks are constantly changing,'' says Randall Abbott, client strategy leader at benefits consultant Watson Wyatt Worldwide in Bethesda, Md. Make the wrong choice now, and you may not get the doctors or benefits you want. Then you have to wait a whole year before you can switch your coverage again. If you work for a big company, chances are you can pick among health-maintenance organizations, which restrict you to a network of approved doctors; preferred-provider organizations, which have an HMO-like system but also give you the option to go out of network; and a traditional indemnity plan, which reimburses you no matter who you see. Generally, the more freedom of choice you have, the more you pay. With companies projecting that their health-care costs will rise 10% to 12% this year, you can expect to see higher premiums for 2001. This is especially true if you want family coverage. Benefits consultants say steep hikes are an attempt to discourage you from enrolling your spouse and children on your plan. ''It doesn't make sense for employers to carry the whole burden, especially when one partner can get insurance elsewhere,'' says Tracy Brown, an account executive at Madison Benefits Group in Houston. At one time, it was common for professional couples to enroll each other and their kids on both their companies' health plans so that one insurer paid for what the other did not. But this is becoming more of a rarity, both because the higher premiums make such a move prohibitive and because employers now often refuse to extend benefits to spouses who are insured at their own jobs. Even if your company's premiums have held steady, don't think your health expenses aren't rising. Most employers are adding restrictions and incidental fees, says Joseph Marlowe, senior vice-president at Aon Consulting Worldwide, a Chicago human resources firm. For example, many policies are upping the co-payment to see a specialist. Paying $15 to $25 for a specialist's services is typical, while $5 to $10 will cover a visit to a primary-care doctor. RANKING PLANS. Prescription coverage is also changing. With spending on drugs rising an average of 11% a year since 1992, more plans now have formularies, or a list of preferred medications. If you take a drug on the formulary, your co-payment would likely be $5 to $10. For nonformulary prescriptions you'll be shelling out $30 to $50. Check whether the providers you like are still participating in your plan because doctors and hospitals often move in and out of networks. If not, and they're part of another plan on your company's list, you would have good reason to switch. Abbott at Watson Wyatt advises people who don't fully understand their policy descriptions to seek clarification from insurer help lines and Web sites. If you're not sure what to ask, the Employer Quality Partnership (EQP), a coalition of employer organizations based in Miami, lists on its site basic things to consider (table). For example: Does the plan fully cover medical conditions that are important to you? Many don't cover--or will cap how much they will pay for--treatment of such disorders as mental illness. To give you an idea of the limits, plans often will cover only 30 visits a year to a psychotherapist, with a maximum benefit of $50 a visit. Other sites, such as the National Committee for Quality Assurance, tell how health plans rank in quality and customer satisfaction. Your state's insurance department has information about complaints or legal sanctions against insurers. There are lots of resources. The onus is on you during open enrollment to take advantage of them. By KATE MURPHY _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ BACK TO TOP					RELATED ITEMS Picking a Health Plan: Inertia Can Be Costly TABLE: Help in Reviewing Your Options INTERACT E-Mail to Business Week Online

Copyright 2000-2008, by The McGraw-Hill Companies Inc. All rights reserved. Terms of Use   Privacy Notice