A health insurance broker loves to talk about all the advantages of switching group health insurance companies, but they never talk about the pitfalls. Today I’m going to review the top 5 pitfalls when shopping or switching group health insurance Reno companies.
To be clear I’m only talking about switching group health insurance Reno companies, not plans. When you keep the same company and switch only the plan, none of the pitfalls I’m describing apply.
When you are considering switching group health insurance Reno companies the first thing you’re going to want to look at is what type of requirements do they have to start the plan. Each insurance company is slightly different. Health insurance small business companies call this underwriting. Usually, you need at least 75% of eligible employees participating, you need the company contributing a minimum amount of the cost and so on. Underwriting is the first thing to take a look at before switching.
Next, you should look at the doctors covered by the new plan. Insurance companies form contracts with medical groups and private practices to get the lowest rate For anyone who needs a specific doctor, you’ll want to make sure that doctor is covered by the new medical plan. So the second is Doctors.
Drugs and drug costs can be affected quite a bit when you are switching group health insurance Reno companies. Insurance companies publish a list of prescriptions. This is called a Formulary. This list categorizes drugs into different tiers (normally 1-4). Based on which tier the drug falls, that determines the cost. The problem is these Formulary lists aren’t standardized. A drug might be a Tier 2 on one list, costing $30 and a tier 4 on another list costing $150. Just don’t assume that because it’s covered as a tier 2 with the company you’re on now, it’s going to be a tier 2 drug with every company.
Another thing to keep your eye on with drugs – If you’re taking an expensive drug a new insurance company may require you to go through Step Therapy. Step Therapy is a process where the patient tries less expensive drugs and moves on to more costly drugs only if those don’t work. Drugs and drug costs are the third pitfall.
If someone in the group has met their calendar year deductible or maximum out of pocket, these will all reset if you are switching group health insurance Reno companies. This is unavoidable. In a video found here, I explain more about how the Calendar Year Deductible works. So a deductible reset is another factor to keep an eye on. In general, losing a credit towards a deductible is your fourth pitfall.
The last pitfall when switching group Reno health insurance companies is choosing the wrong health insurance broker. A good broker knows how to navigate the first 3 problems. They also know to navigate the underwriting requirements with each company. They generally know which medical groups are covered, and they know where to find the list of prescriptions. Choosing the wrong broker can lead to expensive mishaps, gaps in coverage and upset employees. Be sure to rely on a licensed and experienced broker.
If you have specific questions about changing your business over to a different health insurance Nevada company. Please give my office a call. We would be happy to answer your questions.