Haunted by a Health-Coverage Choice
Even if you were shortsighted, you needn't get stuck with a bad policy
Q: My small company didn't sign up for prescription coverage on our employee
health plan. When we later realized we needed it, we couldn't add it until
the one-year renewal came up, so we had an eight-month period with no
prescription coverage that turned into a strain on employee morale. What
should we have done differently?
--I.W., New York, N.Y.
A: Sounds like you made a cost-cutting decision that came back to haunt you.
Most employee health plans these days include prescription drug cards and a
small employee co-payment as a standard feature of the overall package. Some
states mandate prescription coverage, in fact. But experts say that about 20%
of health insurance plans come with riders so employers in certain states can
opt in or out of such items as prescriptions, dental coverage, and vision care, saving
7% to 10% on each option.
Unfortunately, medications are very expensive, and employees are no longer
accustomed to having to pay for them out-of-pocket. As you may have
discovered, companies with health plans that are not up to par wind up with
employees who are filling out job applications behind the scenes and going
elsewhere. Since health coverage is the core of a good benefits package, experts
recommend you spend a little more and keep your workforce happy.
You didn't need to wait until your insurance carrier's enrollment window
opened in order to offer prescription coverage to your employees, however.
Allison Klimerman, spokesperson for the New York State Insurance Dept.,
says that you could have canceled the plan you were on and simply purchased
insurance from a different carrier, picking up the prescription coverage at
that time -- you're not locked in for a full year. If your rates were better
with the first company, you might have gotten back on their policy -- adding drug
coverage this time -- within six months to one year. The employer can cancel
the coverage, usually with about 30 days' notice. The only time you must stay
with an insurance plan for the full term of the coverage is if your insurance
is partially self-funded or you are involved in an alternate funding plan authorized
"Your agent should have helped you shop around, find a new carrier, and elect
a plan with drug coverage. You probably didn't get the time and attention you
should have," says Larry Salovin, president of L&J Insurance Co. in Jupiter, Fla.
Salovin, who specializes in small-business coverage, says that unless small companies
choose a specialty agent, they frequently get short shrift from their insurance representatives.
Micro-businesses must be particularly diligent in locating a broker, says
Kathy Hope, owner of Los Angeles-based Insurance Advisors. "If you're very
small -- under five employees, say -- be prepared to have a tough time getting
coverage because it's not cost-effective for large companies to insure you.
If you go to a big broker, they'll tell you they can't find insurance. But a
smaller brokerage, like mine, will work like crazy to find you coverage
because we want the business."
A few things to consider when picking an employee health plan: Most plans
are priced within a 5%-to-15% range of each other, Salovin says. "More
important than price is the quality of the coverage, the stability of the
insurer, and the accessibility of customer service. I like to show my clients
four or five plans and explain the pros and cons of each," he says. For
instance, some policies do not pay for certain drugs, which may prove to be a
major hardship for one or more of your employees. Other plans, for perhaps
10% over the standard price, offer "open access," meaning employees do not
have to pick a primary-care physician and do not need a referral to
see a specialist -- a major benefit for many people.
For more information on insurance laws -- which vary widely from state to
state -- and employee coverage, visit the Web site of the National Association
of Insurance Commissioners at www.naic.org. The New York State Insurance
Dept.'s Web site is www.ins.state.ny.us. Salovin's Web site,
www.lnjins.com, and Hope's site, www.healthbroker.com, offer definitions,
FAQs, and information on insurance legislation.
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