Health plans can be a lot like a banana split – they can be a basic banana split or can be one with all the trimmings. Which plan is yours?
I have to admit I haven’t had a banana split in years, but I remember them well when we would go to the local Dairy King in the summer when spending weekends at our summer cottage in Michigan. You could either get the basic banana split with bananas, ice cream, and chocolate sauce, or they had lots of other trimmings that you could add, such as different flavors of ice cream, nuts, all kinds of fruit, whip cream, caramel, and the cherry on top. Makes me hungry just writing this article!
We’ve all heard about the postponement of nonessential services and elective procedures during the pandemic, understandably so. While the result was reduced medical claims for groups in 2020, the unintended consequence is that hospitals are increasing their prices to make up for losses during 2020, coupled with the increased utilization by employees who are now receiving those services and procedures that were postponed. This is further complicated by those people whose medical conditions may have worsened because they didn’t get the screenings, tests, and consultations during the pandemic.
When talking to many employers, you might be surprised how many of the health insurance plans that employers offer to their employees are the basic version of the banana split. They keep renewing the same insurance plan year after year and don’t add any of the trimmings that are available on the market to improve their banana split. Some of their plans are historically so basic that they’re still fully insured and haven’t looked at partial self-funding.
There are so many types of trimmings that I couldn’t possibly mention them all here. Notwithstanding the funding mechanisms – fully insured, self funded, level funded, retrospective premium payments, etc. – there are also plan design options. However many of those are standard off-the-shelf designs that an insurance company wants to sell rather than a plan design that an employer wants to offer.
One trimming that has become very popular during the pandemic is tele-medicine, and some plans have added it as a result so employees can seek medical care without having to physically go to a doctor’s office or receive a prescription.
Wellness plans, disease management and lifestyle management are gaining more popularity amongst employers to deal with chronic conditions and potential time bombs for medical care. Increased awareness and attention to mental health during the pandemic has become a necessity as well.
Here is what my “banana split” health plan with all of the trimmings would look like:
- Unbundled self-funded plan utilizing an independent Third Party Administrator
- Independent stop loss contract
- Reference Based Pricing for providers (eliminate the PPO)
- Custom plan of benefits to fit my company culture and employees
- Independent Pharmacy Benefit Manager
- Independent specialty drug company
- Tele-medicine
- Disease Management
- Oncology Management
- Employee Assistance Plan
- Concierge Guide & Advocacy Services
Certainly there are many other benefits that can be offered to employees that are unrelated to a health plan. But those would probably be considered a milkshake, chocolate sundae, or ice cream cone. If you would like to talk about your “banana split” health plan please call me at 970 – 349 – 7707 or email me at [email protected]
