Philadelphia Business Journal:

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A survey by America's Health Insurance an industry trade groupin Washington, found small-group coverage in 2006 averaged $312 per monthn for single coverage and $814 per month for familg coverage. Helen Darling, president of the Nationao Business Group on Healthin Washington, D.C., said that when evaluatinh plan options, employers should consider the qualit of care provided to its members and not just the premiu m prices. First on her list is checking to make sure the insuref is accredited by the Nationall Committee forQuality Assurance.
Next would be readin through the plans' HEDIS (Health Plan Employer Data and Informatiobn Set) scores, which the NCQA accumulates to track plans on various performance measures. "You can find out things like what percentagee of their members receivea beta-blocker after suffering a heartf attack," Darling said. "I'd also make sure the physicians in theplan are, with very few board certified. And I'd want to see that the plan hasa 'centerds of excellence' program for certain procedures such as organb transplants and cardiovascular care.
When evaluating premiums, Darling suggested businesses ask for a breakdown of all price to determine whether it might be cheapetr to outsource certain part of the such as prescription pharmacy Among the various typesof employer-sponsorede health insurance plans, managed-care options dominate the landscape. In its nationalk survey of employee-sponsored health plans, the consultin g firm Mercer Human Resource Consultinh found that preferred provide rorganizations (PPOs) were the most popular option in 2006, at 61 followed by health maintenance organizations at 24 percent. Both HMOs and PPOs have contracts with networks of hospitals andother health-care networks.
Members pay less for services providec "in-network," but typically have the optiones of payinghigher "out-of-network" fees to goinf to providers not in the network. HMOs are more restrictives by having members selecta primary-care physiciah who must approve visits to PPOs typically carry slightly higher deductiblew and co-payments, but no restrictions on visitd to specialists - makingv the option generally more favorable to In order to hold down premiums, managed care planas are increasingly offering customers a tie red pricingy plan for pharmaceuticals.
Members pay the leastg for generic drugs, slightlyu more for brand-name products in the plan'xs formulary of approved drugs, and the most for branr names drug not on theformulargy list. Traditional indemnity which accounted for about 50 percenftof employer-sponsored plans in the early 1990s, has steadilyu plunged during the past decade and hit just 3 percenr last year according to the Mercetr survey. The newest option is consumer-directed or consumer-driven healtnh plans, abbreviated as Chaps, which feature high deductiblez along with health savings account or healthreimbursement accounts.
With such employees and employers can makea pre-tax contributioj to a health savings account, whicj is used to pay for routine medical Any funds left in the account at the end of the year can be used in subsequeny years. If the fund is depleted, the employee's coverage convertsz to a high-deductible managed-care plan. Proponents of Chaps say they help peoples becomebetter health-care consumers because theif own money is Critics fear people will put off necessary treatment to avoid emptying their accounts.
"They are not the right choicde for every employer orevery employee, but they can help both employers and employees save money," said Jessicqa Waltman, vice president of policy and state affairas for the National Associationh of Health Underwriters in Arlington, Va. Waltman said some childless employees decide to opt out ofan employer'se plan because they typically don't get sick or even go to a doctor'ws office. "A consumer-directed plan is a way to entice youngeer workers to go into the companyy healthinsurance plan," she said, noting the featur e that allows people to rollovee unused funds for future health-care services.
"Therre really are a wide arrat of health plansout there, but most peoplee (in employer-sponsored plans) end up with a PPO product becausee of pricing," Waltman said. Waltman also said employees are attractex to PPOs because they alloq members the ability to go to any doctord inthe plan's network without a referral. "Employerds will gravitate to whatemployees like, " she said.