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What to Ask When Buying a Health Insurance Plan

Employees appreciate health benefits. The insurance helps pay for medical bills, and having dependent coverage makes everything even better. Purchasing a health insurance plan is not like buying a truck off the lot. An employer will be incurring costs and obligations that will be corporate expenses for years to come. It’s practical to kick the tires and asked some questions before you buy a health insurance plan. Here are a few questions you should ask.


What is covered?


There are essential health benefits required by law. Any human resources director who is looking for a health plan can dismiss as marketing any emphasis made by a vendor on offering any of these services. However, there may be other additional benefits that a particular health plan might provide, and these may be helpful to the employees. Vision and Dental Care are two that come to mind.


How Many Members Must Be Enrolled in the Plan?


This is especially important for small business owners. Insurance companies have minimum enrollment requirements, usually ten or more employees. You can ask if dependents are included in the minimum enrollments, as well.

Are Claim Audit Services Provided?



Traditional forms of cost-containment, raising premiums or deductibles, are not crowd-pleasers. A better option is to drop health services that are not being used by plan members. A claims audit allows a plan administrator to make some surgical cuts to the health plan by getting rid of unused services. It further enables the plan administrator to add employee desired services to replace procedures that were dropped.


What is the cost of the health insurance plan? Are there any possible discounts?


This is undoubtedly the most important question to ask when the selections have been narrowed down to just a few health insurance vendors. There is no reason to accept the quoted figure unconditionally.

A straightforward question to ask is about a book of business. It is possible in most cases to get a reduction in the overall cost if an employer is willing to include employee life insurance ( ordinarily a multiple of that person’s annual salary) as part of the agreement.

Furthermore, a buyer must understand that the insurance provider wants the premium money. You do not have to give it to them in monthly payments. 

The additional question to ask about cost is there any administrative discount if the company decides to pay the premium bi-annually or quarterly. It is possible to get a discount if the premium is paid in different periods.

What are the deductibles and copayments?

A buyer should ask if there are any differences between a person with single or dependent coverage. If the initial deductible or copayment is unacceptable, it is legitimate to ask what the cost would be if different amounts were charged to the employee.

Who will administer the plan?

The cost is going to be higher if the provider is required to do the administration. There is software available that can allow an employer’s human resource department to do all the administration. It is also possible to have a third-party administrator (TPA) do the work for you. A professional employment organization (PEO) is an option that a small business may consider.

Are there provider options?

Does the plan provide for HMO or PPO membership?

The last question is vital for employees who have small children. There other questions such as can a plan member keep his or her doctor and is there a wellness plan? It also is a smart idea to inquire if the insurer will help with enrollment and publicity.


It is a smart idea to work with a licensed health insurance broker to find the best plan for your according to your unique needs and situation. Our licensed agents are available for you to call today to learn more.


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Alex from Omaha, Nebraska
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