4 Questions You Should Be Able to Answer About Your Employer-Sponsored Health Insurance

by CoVaBizMag

Health benefits enrollment is a once-a-year “event” for most folks in a traditional employer-sponsored model. Typically an email goes out–with some attachments, or maybe a web portal–and a deadline is given: “Let us know your choice before…!” It’s a hurry-hurry-hurry approach that can offer broker assistance to individuals if needed, but really counts on folks figuring out things for themselves most of the time.

And then, the details are forgotten (if they’re ever truly understood in the first place). Almost immediately. Because life brings us other, more important tasks to tackle, like child-rearing, job performance and Kardashian reruns.

Here are four questions you should be able to answer year-round, even when you’re healthy:

1. What insurance company are you with? 

For most companies in Hampton Roads with less than a couple hundred employees, you’ll be with Optima or Anthem in a fully-insured program. They’re the two “big cheeses” in the area. Know which one.

If you think you’re within someone else–Cigna, Aetna–then you may be part of a more complicated self-funded model. Questions? Shout to bfinemd@percentric.com.

2. What is your deductible? 

The term ‘high-deductible’ has had an evolving definition over the years. There is a subjectiveness inherent to the term, as ‘high’ to one person (i.e., “Two thousand dollars may as well be two million,” to some entry-level workers) is pocket-change to another. What the term means in the “industry” is an attempt to define what plans are eligible for Health Savings Accounts (HSAs). And that eligibility, while subject to a handful of criteria, really has more to do with the payment model than the numerical value of the deductible. 

Bottom line: Start small by knowing what your deductible is, then you’ll position yourself to start being a better self-advocate for non-emergent medical decisions.

3. Who is your primary care doctor?

So, this guidance comes less from the health-insurance-requires-me-to-have-a-primary-care-doctor school of thought, and more from the how-to-manage-your-health mindset. Mostly, healthy folks in their 20s and 30s might not be able to answer the question because, well, they’re healthy. And, they haven’t seen a doctor in a while (especially the men). But taking a step to identify a health provider not only gives you a head start if/when issues arise, but also pushes you toward utilizing one of the services you’ve already paid for with your health insurance premiums–preventive care.

4. What are your co-pays for primary care, urgent care and emergency room services? 

Knowing the answer to this question offers a couple advantages. First, if you come to realize that the answer is, “$0”, then you’ll begin to understand the difference between a first-dollar assistance insurance plan (the more ‘classic’ model) and an HSA-eligible high deductible plan. With the latter, co-pays are generally disallowed by rule, and premiums tend to be significantly lower.

Additionally, you will come to identify where you might want to go in the non-emergent situations when you need or want medical care. There are cost incentives for you to be judicious in choosing where you seek out care, most specifically in those situations where acting judiciously is itself judicious. 

Don’t know the answer to these questions? Take the five minutes right now and seek them out.

About the Expert

Pediatrician Dr. Bryan Fine has been a physician for more than 15 years, and is the founder of Percentric, an innovative, physician-led health benefits optimizer. Visit Percentric.com to learn more.

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