Minneapolis / St. Paul Business Journal:

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A survey by America's Health Insurance an industry trade groupin Washington, found small-group coverage in 2006 averaged $312 per montjh for single coverage and $814 per month for family Helen Darling, president of the National Businesws Group on Health in D.C., said that when evaluatint plan options, employers should consider the qualitty of care provided to its members and not just the premiukm prices. First on her list is checking to make sure the insurer is accredited by the Nationa l Committee forQuality Assurance. Next woulcd be reading throughthe plans' HEDIS (Health Plan Employer Data and Information Set) which the NCQA accumulates to track plan s on various performance measures.
"You can find out thingw like what percentage of theit members receivea beta-blocker after suffering a heart attack," Darlin g said. "I'd also make sure the physicians in theplan are, with very few board certified. And I'd want to see that the plan hasa 'centersz of excellence' program for certainn procedures such as organ transplants and cardiovasculafr care." When evaluating premiums, Darling suggested businesses ask for a breakdowj of all prices to determine whether it mightg be cheaper to outsourc e certain part of the plan, such as prescription pharmacuy benefits. Among the various types of employer-sponsored healtg insurance plans, managed-care options dominate the landscape.
In its nationa survey of employee-sponsored health plans, the consultingv firm Mercer Human Resource Consulting found that preferred providerorganizations (PPOs) were the most popular optionj in 2006, at 61 percent, followerd by health maintenance organizations (HMOs) at 24 Both HMOs and PPOs have contractz with networks of physicians, hospitals and other health-care networks. Membersx pay less for servicesprovided "in-network," but typically have the options of payinv higher "out-of-network" fees to going to providerxs not in the network.
HMOs are more restrictivd by having members selecta primary-carwe physician who must approve visits to PPOs typically carry slightly higher deductibles and but no restrictions on visits to specialistds - making the option generally more favorabld to members. In order to hold down premiums, managed care plans are increasinglgy offering customers a tie red pricing planfor pharmaceuticals. Memberzs pay the least for generic drugs, slightlg more for brand-name products in the plan's formularu of approved drugs, and the most for brand names drug not on the formulary Traditionalindemnity coverage, which accounted for aboug 50 percent of employer-sponsoree plans in the early 1990s, has steadily plunged duringh the past decade and hit just 3 percenty last year according to the Mercer survey.
The newest option is consumer-directed or consumer-driven health plans, abbreviated as Chaps, which feature high deductibles along with health savingws accounts or healthreimbursement accounts. With such employees and employers can makea pre-tax contributionj to a health savings account, whicy is used to pay for routine medical care. Any fundds left in the account at the end of the year can be used insubsequenft years. If the fund is depleted, the employee'sw coverage converts to a high-deductibl e managed-care plan.
Proponents of Chaps say they help peoplre becomebetter health-care consumers because their own money is Critics fear people will put off necessarhy treatment to avoid emptying theidr accounts. "They are not the right choice for everg employer orevery employee, but they can help both employeras and employees save money," said Jessica Waltman, vice president of policy and stater affairs for the National Association of Health Underwriteres in Arlington, Va. Waltman said some childless employees decide to opt out ofan employer'sz plan because they typically don't get sick or even go to a doctor'sx office.
"A consumer-directed plan is a way to enticew younger workers to go into the companhy healthinsurance plan," she said, noting the feature that allowsd people to rollover unused funds for futurr health-care services. "There really are a wide array of healty plansout there, but most peopl (in employer-sponsored plans) end up with a PPO product becausee of pricing," Waltman said. Waltman also said employees are attracteds to PPOs because they allow memberws the ability to go to any docto inthe plan's network without a "Employers will gravitate to what employees like,"" she said.