Nov. 1, 2019 – Today marks the beginning of the open enrollment season for health care coverage.
As you review your existing health care coverage, the State Bar association health plan (AHP) is another option for you to consider in finalizing coverage needs for 2020. Coverage under this plan is provided by Wisconsin Physicians Service Insurance Corporation (WPS, WPS Health Insurance, Arise Health Plan, or WPS Health Solutions). In Dane County, coverage is provided by Quartz.
The association health plan is a group plan for employers to offer employees (attorneys and staff) and their eligible dependents. It is available to Wisconsin law firms with two or more nonfamily-member employees that are considered employers under current plan regulations.
‘How Much Is It Going to Cost?’
That’s the first question everyone asks when looking at health plans.
A good way to reduce your health coverage costs is to stop smoking. Smokers can be charged up to 50% more for the very same plan as a nonsmoker, according to Insure.com.
Emphasis within your firm on health and well-being, and incentive programs aimed at increasing physical activity and healthy eating all work to your firm’s advantage in reducing health care costs.
While there is no denying that premium is an important consideration, the true cost of any health plan is more complicated than just the outlay for premiums.
The process of reviewing health coverage may be daunting, but here’s a few helpful suggestions to ease the process.
First, you can avoid unnecessary health care costs by selecting coverage where the physicians you and your family use most frequently are considered in-network or preferred providers – those having a contract with your health insurer or plan to provide services to you at a discount.
Second, identify the potential for out-of-pocket costs associated with any plan you’re considering. Paying attention to these key components will impact your overall costs associated with health coverage:
deductibles: the amount you owe for health care services under your health insurance or plan before your coverage begins to pay;
co-pays: a fixed amount you pay for a covered health care service when you receive the service;
out of network charges: costs associated with service providers who do not contract with your health insurance or plan; and
out of pocket maximums: an identified amount you pay during a policy period before your health insurance or plan begins to pay 100% of the allowed amount.
While it is impossible to know what all of your future costs may be, look at the past few years’ expenses for medical costs such as prescription drugs, office visits, and other medical care to help anticipate your needs in the future.
Consider your financial situation and to what extent you are able to absorb higher out of pocket expenses and balance this against potential premium savings with plans that provide less comprehensive coverage.
Consider how prescriptions are covered, and take the time to inquire as to formularies so you understand not only the coverage difference between generic, bioidentical, and specialty drugs but the real cost difference between them. Inquire as to whether or not there is a separate prescription deductible. Heavily advertised drugs are not necessarily the best or most effective in all cases – ask your physician and pharmacist if there are less expensive options.
Be an Educated Consumer
Professional health insurance agents can walk you through the myriad offerings, and advise you based upon your specific needs. They will also be able to advise you on the important value added features offered by some carriers, such as Teledoc®, medical management programs for certain conditions, adherence programs, and site of care management. These types of programs can make your utilization experience more positive.
Lastly, consider the various funding options available, such as Section 125 premium-only plans and FSAs, HRAs, and HSAs. While these don’t reduce your cost, they provide tax advantaged methods of paying for premiums and out-of-pocket medical expenses.
Being a good consumer of anything requires being an educated consumer and seeking advice from knowledgeable professionals.
For help in understanding the terminology involved, see the glossary to Health Coverage and Medical Terms.
For More Information on Health Insurance
The State Bar of Wisconsin is committed to helping members find solutions to their insurance needs. For more information and frequently asked questions on the State Bar association health plan, see “New Association Health Plan Gives Small-firm Members a New Health Care Option,” in the Sept. 18, 2019, issue of InsideTrack.
For information and quotes on the State Bar-sponsored association health plan, contact:
Professional Insurance Programs (PIP)
Keep these health-related options in mind to address your health care needs:
- Group Dental Plan through Delta Dental
- EyeMed Vision Plan
- Coming soon: Critical Illness and Accident Coverage
For more information on these types of insurance, contact:
Bultman Financial Services, Inc.
(800) 344-7040 or (262) 782-9949