Human Resources News & Insights

Getting more from your health insurer than just a bigger bill

stethoscope-squeezing-money

New research shows there are extras you can get from your health insurer. You just have to know what to ask for.

The research comes in the form of a study, What Employers Want from Health Insurers in 2010, by the Health Research Institute of PricewaterhouseCoopers. It tracks the worst areas of dissatisfaction with insurers and what companies are demanding — and getting — from their insurers.

The key for you, in your next negotiation with your carrier, is knowing what the insurance companies are hearing from other customers so that you also know what’s reasonable and common and what’s unlikely. And then you can gauge your requests and negotiations accordingly.

Here’s what employers are typically going after, according the study of companies ranging from large (up to 11,000 workers) to tiny, including some consisting of no more than several employees:

A partnership with insurers to improve the health of the workforce. Rather than insurers’ just telling employers, “Improve your workforce’s health and we’ll limit your costs,” employers are demanding plans and assistance with health improvement — or in the vernacular of the day, “wellness.” Check with your carrier to see what programs are available or are in development.

More data in general about health and common health problems. Insurance companies have mountains of data about typical types of claims, high-risks and other situations that employers can use to benchmark against their own situation. Within the bounds of privacy, insurers can provide some of that data to you to help you benchmark your own successes and workforce tendencies. You can start by asking your insurer, “What data do you have that might help us with our wellness program or figuring out whether our claims are high, low or in the middle?”

Info about what works and what doesn’t. For instance: Is it better to reward employees for completing health risk assessments? Or is it better to reward healthy behaviors. Insurance carriers have reams of statistics on effective management of employee health — and health costs.

The study also produced a lot of statistics about employer satisfaction — or dissatisfaction — with their carriers. You can measure your own complaints against those that popped up more often in the study.

Larger companies tended to complain more about lack of health-risk profiles, not enough access to relevant records, and slow advancements in technology tools, such as debit-card interfaces.

Smaller companies griped most often about lack of health-risk profiles, not enough discounts, no disease-management programs and not enough online tools.

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  • Judy

    I was recently at a seminar where we as small businesses were encouraged to try and get health data from our carriers. It seems that this is an impossible task especially for the small business. I would like to here what other small business experiences have been in this area.

    We are just starting to address health and wellness both for the population we serve as well as for our own employees. Having very young employees presents certain challenges in regards to getting them to look at their own habits and assess how healthy they really are.

    On another note we changed carriers this year and I have been so disappointed with the new carriers website. It is NOT user friendly at all both for myself as a participant as well as the administrator of the plan.

  • Rhonda

    I brought up wellness programs to our insurance carrier (a rather large, well known carrier) of two years now and the response I received was nothing short of appalling. He looked me right in the eyes and told me that wellness programs are a sham and have been proven time and time again to be costly, burdensome and worthless. Of course, when our Operations Manger & Accountant heard this, they have never let me bring up the subject again.

    Anyone have any suggestions for resources that show a correlation between wellness programs and ROI? We have close to 250 employees in three states, and our insurance expenses just keep going up!

  • JohnnyHR

    Rhonda – You should talk to another representative of your insurance carrier. Whoever it was you talked to is (1) wrong and (2) and P-poor rep for your carrier. If his attitude is the same as his employer, find another carrier. Wellness programs make sense. They address such things as encouraging people to get regular preventative checkups, diet counseling, exercise counseling, smoking cessation programs and drug and alcohol counseling. Common sense says these things are beneficial to the overall health of an individual and in the long run serves to keep health care costs down. My guess is your rep replied as he did because they have a weak wellness program. Find a carrier that has a good one.

  • Debbie Lawrence

    Good Morning Rhonda,
    I am sorry you had such a bad experience with your carrier. We started a Wellness Program on January 1st and so far we have had 6 employees that quit smoking and have been smoke free for at least 6 months. We have had several employees with large weight losses and a few that are no longer taking prescription meds for chronic ailments. In addition, we offer a $20 gym subsidy per month and you must prove you worked out at least 10 times that month to be eligible. Out of 240 employees 110 are a part of the subsidy. We have had great success with very little investment.