Module 3 Selecting and Designing Benefits Plans Flashcards
What are important things to consider when designing a benefits plan
Consider gap analysis
Consider desired state
What are important things to consider when designing a benefits plan
Consider gap analysis
Consider desired state
When designing a benefits, plan what benefits are considered healthcare benefits
Medical
Behavioral and mental health
Wellness
Prescriptions
Dental
Vision
Tax advantage accounts
Long-term care
When designing a benefits plan, what benefits are considered welfare benefits
Short and long-term disability plans
Life insurance
EAP
What benefits are legally required by employers?
Worker’s Compensation
Unemployment insurance federal and state
Federal Social Security
Medical
Some states require state disability insurance
In benefits plan design, considering scope and depth considerations, describe degree of choice
How much choice will be offered
Is it financially viable or even advisable for the organization to do so?
Is infrastructure in place for support
Is the culture right to support the degree of choice? Do you want to offer?
When designing a benefits, plan, scope and depth of considerations what administrative support considerations should be made
Will administration occur, in-house or outsourced
Many plans have different administration requirements and more than likely some plans will be administered by your own staff, while others will be outsourced
When considering plan design, what are some common plan considerations?
Employee demographics
Employee opt out provisions
HRIS capability
Collective bargaining agreements
Healthcare delivery model
What is the traditional healthcare delivery model?
Employer, sponsored and defined benefits plans
Employer typically offers limited choices of plan, design options, each with specialized levels and cost
May have HSA or FSA
Examples include PPO, HMO, POS, CDHP
Employer premium contributions often vary
Regarding healthcare delivery model, what are private exchanges?
A private exchange may include a business typically operated by consulting firms, brokers, insurers that sell insurance products to healthcare consumers
Why would an organization use private exchanges?
Enable healthcare consumers to shop from a wide variety of major medical health plans
Offered decision support or employee recommendation technology services that may not be offered in traditional settings
Provide transaction services
Employers often give up control of plan design and its cost at the desired threshold
Can provide employees with more choices their employer could offer them
What are characteristics of private exchanges?
Range from single carrier platforms to multi carrier platforms, insured, and self insured
Use as a defined contribution approach to healthcare where employers provide a fixed subsidy to their employees to purchase coverage
Private exchanges offer benefits, administration, services, employers, and support individual healthcare consumers
What questions should we be asked regarding private exchanges
What role does the employer wanna play in healthcare?
What are the employers long-term strategy and employee value proposition?
Is the private exchange considered individual or group market coverage?
What’s the competition doing?
What role does the employer want to play? Improving health and wellness of its employees
What’s the exchange underwriting model does adverse selection a role within the exchange model
Will joining a private exchange, improve the employees access to high-quality health plans
Who owns the private exchange?
How would the HR function change?
When designing a benefits plan what medical plan considerations are to be taken?
Structures for medical plan PPO, HMO, POS, CDHP
Health, promotion programs
quality, and efficiency initiatives
Carve out programs (prescriptions, vision, mental health)
Covered family members
Network (discount in size, doctor ratings, hospital ratings)
Prescription drug plan considerations, what are ways that you can reduce costs
Pharmacy benefit managers
Cost sharing techniques
Tears of covered drugs
Step therapy
Mail order
Specialty pharmacies
