BOSTON--(EON: Enhanced Online News)--Under the Affordable Care Act (ACA), consumers will be making history this fall as the first generation mandated by the government to have individual health care coverage. One market segment, the working insured, will now have more choices beyond their employer-funded health care plans as insurance marketplaces come online. However, before making any choices, HighRoads, the leading benefits plan management system provider for Fortune 1000 employers and key payers, suggests consumers thoroughly research all options to make sure their new choices meet their health and financial needs.
“We first suggest employees read their Summary of Benefits and Coverage (SBC) documents as a benchmark from which to compare all options in employer-provided plans and marketplaces”
“We first suggest employees read their Summary of Benefits and Coverage (SBC) documents as a benchmark from which to compare all options in employer-provided plans and marketplaces,” said Cynthia Weidner, vice president, HighRoads. SBCs, which HighRoads provides through its benefits plan management system, are ACA-required documents detailing essential benefit coverage and distributed to each participant. “SBCs will help consumers pinpoint what exactly they’re getting in coverage, and will help in making comparisons,” said Weidner.
HighRoads recommends these tips for consumers as they make open enrollment choices:
- Remember the Tax Man. The ACA requires consumers to have coverage this year, but that coverage doesn’t have to come through your employer. Keep in mind, however, that if you buy coverage in the marketplace, you will have to pay your premiums with after-tax dollars. You probably won’t qualify for tax credits and your employer won’t share the cost of coverage with you.
- Match Your Plan to Your Profile. If you’re young, healthy and single and don’t have a family history of health problems, you probably don’t need to pay for “gold” level premium coverage. On the other hand, if you have young children and are diabetic, you might want a richer plan. Take a very close look at what you can afford and be realistic about your medical care needs this year. Pick the plan that is the best match. This applies whether you’re choosing among options your employer offers, or between your employer and marketplace options.
- Use Available Research Tools. Don’t go it alone. To help you choose from the range of choices in the marketplace, each state will have navigators available. These include Enroll America and eHealth. Use these online tools for basic information and to research your various plan options.
- Read the Fine Print. If you’re debating between your employer’s plan and an option on the exchange, look carefully at what’s covered. Because health plans on the exchange must mirror your state’s benchmark plan, covered services and prescription drugs will vary from one state to another. Your employer’s plan (if applicable) may be the better deal for you. Check out WebMD’s map to find out more about your state.
- Stay Networked. Before purchasing a plan, look carefully at what provider network the insurance payer is offering in the product. Some plans are lower cost because they have a more limited network and may not include the hospital or doctor a member wants to see.
For more than 14 years, HighRoads has been an industry leader in benefits plan management and health care compliance. Its patented SaaS-based technology, The Source™, streamlines dynamic data management, optimizes workflow across the enterprise and ensures regulatory compliance. The privately held company is headquartered in Woburn, Mass. For more information, visit HighRoads.com, become a fan on Facebook, a follower on Twitter (@HighRoadsHR), or read the HR Compliance Connection Blog http://hrcomplianceconnection.com.