Philadelphia Business Journal:

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A survey by America's Health Insurance Plans, an industry trade groupo in Washington, D.C., found small-group coverage in 2006 averageds $312 per month for single coverageand $814 per mont h for family coverage. Helen president of the National Business Group on Healtbin Washington, D.C., said that when evaluatinyg plan options, employers should consider the quality of care provided to its members and not just the premiu prices. First on her list is checking to make sure the insurer is accredited by the Nationa l Committee forQuality Assurance.
Next wouldd be reading throughthe plans' HEDIS (Health Plan Employetr Data and Information Set) scores, which the NCQA accumulates to track plans on various performance measures. "You can find out thingzs like what percentage of theit members receivea beta-blocker after sufferinvg a heart attack," Darling said. "I'd also make sure the physicianss in theplan are, with very few board certified. And I'd want to see that the plan hasa 'centerz of excellence' program for certainm procedures such as organ transplants and cardiovascular care.
" When evaluatinvg premiums, Darling suggested businesses ask for a breakdow n of all prices to determine whether it mightr be cheaper to outsource certain part of the such as prescription pharmacy benefits. Amontg the various types of employer-sponsorec health insurance plans, managed-care options dominatd the landscape. In its national survey of employee-sponsoreed health plans, the consulting firm Mercerd Human Resource Consulting found that preferrefd providerorganizations (PPOs) were the most popular optioj in 2006, at 61 percent, followed by health maintenance organizationsd (HMOs) at 24 percent.
Both HMOs and PPOs have contracts with networkzof physicians, hospitals and other health-care networks. Members pay less for servicezsprovided "in-network," but typically have the options of payinvg higher "out-of-network" fees to going to providers not in the HMOs are more restrictive by having members select a primary-care physicia who must approve visitw to specialists. PPOs typicallyu carry slightly higher deductible sand co-payments, but no restrictions on visitw to specialists - making the option generally more favorables to members. In order to hold down managed care plans are increasingly offering customers a tie red pricinb planfor pharmaceuticals.
Members pay the least for generic drugs, slightly more for brand-namer products in the plan's formulary of approved and the most for brand namezs drug not on the formulary list. Traditional indemnity coverage, which accounted for about 50 percentof employer-sponsoreed plans in the early has steadily plunged during the past decadr and hit just 3 percent last year according to the Merce survey. The newest option is consumer-directedf or consumer-driven health plans, abbreviated as Chaps, which featur e high deductibles along with healtgh savings accounts or healthreimbursemenyt accounts.
With such employees and employers can makea pre-tax contribution to a health savings which is used to pay for routinse medical care. Any funds left in the account at the end of the year can be used insubsequent years. If the fund is depleted, the employee'es coverage converts to a high-deductible managed-care plan. Proponents of Chapss say they help people becomebetter health-carwe consumers because their own money is involved. Criticse fear people will put off necessary treatmentf to avoid emptyingtheir accounts.
"They are not the righy choice for every employer orevery employee, but they can help both employerxs and employees save money," said Jessicq Waltman, vice president of policy and statre affairs for the National Association of Health Underwritersd in Arlington, Va. Waltman said some younger, childlessz employees decide to opt out ofan employer's plan becausw they typically don't get sick or even go to a doctor'se office. "A consumer-directed plan is a way to enticew younger workers to go into the company healthinsurance plan," she noting the feature that allow people to rollover unused funds for future health-care services.
"There reallyu are a wide array of health planwout there, but most people (in employer-sponsores plans) end up with a PPO product because of pricing," Waltman said. Waltman also said employees are attracted to PPOs becaus they allow members the ability to go to any doctore inthe plan's network without a "Employers will gravitate to what employeed like," she said.