So you’ve found a plan that offers the right benefits for the right costs, offers the provider choice you want, and passes your scrutiny as a solvent and well-run company. What next? Below we explain the steps involved in sealing the deal and implementing your plan.
Signing the Contract
Once you’ve reviewed your options and made your decision, it’s time to sign your contract and make your first payment. Remember that the rates you are quoted will be available for only a limited time—usually 30 days—so if you find a plan that will work for your business, don’t delay too long.
Communicating Information to Employees
You need to tell employees some critical details about how the health plan will work for them, such as:
- What you’re offering. Tell employees which plan types and designs they can choose from, and what their costs will be for both premiums and cost-sharing arrangements such as copayments or deductibles.
- How it works. You will save yourself many headaches if you ensure that employees know how to use their health coverage, including choosing doctors, understanding in- and out-of-network rules, and so on.
- How to enroll and use the plan. Enrollment and coverage start dates are especially important to anyone who is new to the plan. Explain how to complete the enrollment form and begin using the insurance.
- How much it will cost. Make sure employees know what premiums will be deducted and what, if any, copayments or co-insurance they’ll be responsible for. Remember to lay the groundwork for how you plan to share costs in the future.
- How to waive coverage. Some employees may have coverage through a spouse or family member, or may simply not want to participate. If so, they will need to know how to refuse coverage through your company’s health plan.
Employees typically need to complete an enrollment form, and may need to choose a primary care physician (PCP) from the provider directory (typically with HMO and POS plans). Some insurers are moving to online enrollment to minimize errors and speed up coverage.
After employees enroll, they will receive an ID card to present at the doctor’s office or hospital. Sometimes the ID cards do not arrive for a month or so after coverage begins. You will want to let employees know when they can expect it, and whether it will be mailed to their home or to the office. In the meantime, the insurer can provide you with the group and member numbers, as well as how to get prescriptions filled or receive care before the card arrives.
It’s a good idea to hold an employee meeting to answer questions and to explain how to fill out enrollment forms, choose the primary care physician, and file claims. An agent or broker can assist you before, during, and after the meeting.
Offering group coverage requires a lot of paperwork. You’ll need to pay attention to:
- Monthly invoices. Failure to pay premiums is one of the few reasons that an insurer can drop your coverage. Be sure to get your payments in on time, with the accurate amounts for each employee.
- Eligibility. Make sure that you provide updates to the insurer to reflect any changes, including new employees, terminated employees, and dependent changes. (For details regarding your obligations toward terminated employees, see “Laws Related to Health Insurance,” particularly the sections on COBRA and HIPAA.)
- Helping employees with questions. Your employees are likely to have questions about referral procedures, incorrectly processed claims, network providers, or covering loved ones. Making sure that employees have current plan information may cut down on the number of questions you receive.
See the resources that may be helpful to you or your employees if problems do arise with your health plan.
You’ve completed the step-by-step process. For more information, go on to the Reference Guide, which provides further details and resources on many topics.