What Makes a Good Health Insurance Package for Employees?

Thinking about health insurance benefits for your team? Finding the right balance between offering good coverage and managing costs for your business can feel tricky, but you’re not alone. Read on for key information on getting started and what’s important to consider.

Today’s Group Health Insurance Landscape

The Affordable Care Act (ACA) has dramatically changed the way many Americans get their health insurance. That’s especially true for smaller businesses and their employees. The Kaiser Family Foundation (KFF) reports that nearly half of Californians (47%) had job-based health insurance in 2023. In 27 other states, the percentage of people with employer-sponsored coverage was even higher. See the data here.

With most people relying on workplace health insurance, what do employees wish their bosses understood about their ideal group health and benefits package? What really matters to them?

Surveys show that five key factors stand out:

Health care choice: This includes a wide range of options like HMOs, PPOs, and HSA-compatible plans, along with coverage from multiple carriers. One-size-fits-all no longer works. Just as you and your employees are unique, your health care needs are unique as well.

Affordability: In today’s competitive talent market, it’s essential to choose a group health program that benefits both your business and your employees. The ACA has introduced new options, giving business owners more flexibility in how they contribute to employee premiums. You can either pay a Fixed Percentage (50% to 100%) of a specific benefit or a Fixed Dollar Amount per employee. Just keep in mind that your contribution must be the same for all employees.

Broad coverage: The ACA mandates that health plans must cover 10 “Essential Health Benefits,” including:

• Ambulatory patient services (outpatient care you get without being admitted to a hospital).
• Emergency services.
• Hospitalization (like surgery and overnight stays).
• Pregnancy, maternity, and newborn care(both before and after birth).
• Mental health and substance use disorder services, including behavioral health treatment (this includes counseling and psychotherapy).
• Prescription drugs.
• Rehabilitative and habilitative services and devices (services and devices to help people with injuries, disabilities, or chronic conditions gain or recover mental and physical skills).
• Laboratory services.
• Preventive and wellness services and chronic disease management.
• Pediatric services, including oral and vision care. (Adult dental and vision coverage aren’t essential health benefits.)

 ACA-compliant plans must also include birth control benefits and breastfeeding coverage.

Improved protections: The ACA stops insurance companies from canceling coverage if you get sick. It also ensures people can’t be denied coverage because of a pre-existing condition. Additionally, it prevents insurers from charging women more than men for the same coverage.

Dependent coverage: Whether they’re single or married, dependent health coverage is important for many employees. The ACA allows a parent to maintain a child’s coverage through age 26. Under the ACA, a parent can maintain coverage for child through age 26. Employees’ children can stay on their parents’ plans. It does not matter if they are married; have or adopt a child (of their own); start or leave school; live in or apart from their parents; are not claimed as tax dependents; or turn down job-based coverage of their own.

This video highlights key points to look for in a health insurance package:

 

Talk with Your Broker to Learn More

Your broker can give you more details about the ACA and insurance options, including state public and private exchanges, Covered California for Small Business (CCSB) and CaliforniaChoice.

CaliforniaChoice offers many value-added benefits through its Business Solutions Suite and Member Value Suite:

• Discount Dental through 20,000+ providers in the Dentegra® Smile Club.
• Savings on Vision Care through EyeMed Vision One. Receive discounts on frames, lenses, and eye examinations at LensCrafters, Pearle Vision, and Target Optical as well as independent practices.
• EPIC Hearing Discounts. Save up to 50% on hearing-related products and hearing tests.
• Active&Fit Direct®. Access thousands of digital workout videos, lifestyle coaching, classes from world-class instructors, and fitness center memberships at just $28 per month at 12,700+ fitness centers nationwide.
• Cal Perks. Savings on movie tickets, theme parks, sporting events, travel, food delivery services, flowers and gifts, online education, and much more.
• California Rx Card. Take advantage of up to 80% savings on prescription drugs at more than 68,000 pharmacies nationwide. Your out-of-pocket cost when using the card could be less than your copay with health insurance.

If you don’t have a current broker, we make it easy to search for one online.