California health
insurance
Understand Health
Coverage
California health carriers ComparedCompare the major
California health insurance carriers
 Let's look at 5 important considerations
when comparing carriers in the California health insurance
market.
1. Let's be honest...pricing is really important right now.
In
fact, as medical costs have skyrocketed over the past decade,
cost is now the driving factor and it's only going to get
worse. This has led to a wholesale move down the benefit scale
to offset rate increases. Enter your company's census
information (employee age, dependent make-up, and zip codes) in
our Group quoting engine. Then, the best way to find the
pricing/benefit sweet spot is find a baseline benefit level (say
40 copay, $750 deductible, brand rx, and $4000 max out of
pocket) and then find each carrier's closest PPO plan to this
level.
2. Large HMO and PPO networks of doctors
and hospitals. The networks of the different major carriers are
similar but not exact. 90% of the doctors and hospitals will be
similar from carrier to carrier but there will be different and
ultimately, what really matters is that your doctor and hospital
participate. It's hard to choose a carrier and plan for an
entire company up front but you can request doctor/hospital
choices from your employees to check against the provider online
search for the plan that meets item #1 above. Again, most
likely, any of the major carriers will address most of their
needs. You can find the provider directory
here.
3. Plan and benefit flexibility. We want
it all. We want the option to choose from lots of plans be it
HMO, PPO, HSA, or HRA and we want to be able to offer all these
plans to our employees with a fixed contribution as the
employer. That's all we want! The good news is that we can
have that now. Most of the major carriers offer an ability to
do this now and they have dozens of plans available from
catastrophic plans to very rich HMO and PPO options with
little cost sharing. Watch for the new move towards generic
coverage only as this has implications later on.
4. We want the day to day with a carrier
to be easy. You're busy either running or working for a
company. The last thing you need is chasing around claims or
membership issues. As your licensed broker, we can help you
with these issues but we can attest to the definite need to deal
with a California carrier who is easy to deal with. From
dealing with them all on a daily basis, there are definitely
differences on this front.
5. Rate increases going forward.
Cost on
the group health insurance market just keeps climbing. Although
we can switch group health plans annually (or at any point
really since the contract is month to month), it's never
pleasant so ideally, we want a carrier that is stable in terms
of pricing. This is function of plan design, financial
strength, management, and of course pricing strategy.
California health insurance Carrier by Carrier
detail
Anthem Blue Cross
Anthem is one of the strongest, nationwide carriers...probably
in the top three.
1. Plan Pricing - their pricing is generally in the top 2-4
carriers for the California group market.
2. Network - Anthem has one of the largest PPO networks in the
State and the allow participation in the
Blue Card network for family members or employees in other
States.
3. Flexibility - They were the first to offer a true
cafeteria-like flexibility called Employee Elect where you could
offer all their plans (or almost all) to each employee. They
extended this to their dental options as well.as well. On the
individual side, they consistently bring out new plans on the
PPO and HSA side.
4. Ease of Use - Traditionally they have been the easiest to
deal with. They were the first to bring out online applications,
the ability to email membership requests, and credit card for
initial month premiums. Online tools are available on the Group
side to streamline changes, additions, and questions.
5. Pricing Stability - Their increases have been low to middle
depending on the market segment with HMO's being lesst
competitive than PPO and HSA plans.
Blue Shield of California
Blue Shield of California a very strong carrier in California
which has become even more aggressive on the market in the
recent few years. Blue Shield is one of the few non-profits on
the market and it has always been an advocate of consumers in
the market. Blue Shield offers a good PPO comparison to Anthem
and Health Net and it is very competitive on the Small Group
market currently.
1. Plan Pricing - they are consistently
priced in the top 1-3 for comparable plans.
2. Network - For PPO plans, they compare well with Anthem in
most counties. They do allow access to the Blue Card network
for employees or dependents in other States. Their HMO is
comparable to Cross but neither is thought to be the strongest
carrier for HMO plans.
3. Flexibility - They offer plans in the HMO, PPO, HSA, and
HRA segments across individual and group with multiple
deductibles, copays, and price points.
4. Ease of Use - This is where Blue Shield has made so much
progress. Over the last few years, Blue Shield has made great
gains in terms of how easy they are to deal with on a day to day
basis. It's been a huge improvement.
5. Pricing Stability - Their pricing is extremely competitive on
the Small Group market. On the individual side, their newer
plans are priced higher but are richer in benefits.
Health Net of California
Health Net of California was originally Blue Cross' HMO many
years ago. Traditionally, they were a strong HMO carrier but
they have aggressively moved into the PPO market as the future
of HMO's and its cost structure dimmed. Health Net has become
very strong on Small Group market and they have come out with a
very aggressively priced individual family market.
1. Plan Pricing - Today, Health Net's individual plans are
probably the lowest priced on the market. Their group plan
pricing tends to be in the top 1-3 on the market with a strong
HMO pricing model.
2. Network - Health Net has a strong HMO network as that has
been their bread and butter long before the PPO came along for
them. The PPO network is solid although likely smaller than
Anthem or Shield with their focus on PPO.
3. Flexibility - Health Net allows a cafeteria type Small
Group offering where you can offer many plans to carriers. On
the indvidual market, they have narrow range of plans but they
are priced very well.
4. Ease of Use - Health Net tends to be pretty reasonable
both in terms of enrollment (underwriting) and membership. They
have catched up with Cross and Shield in terms of online
capabilities and systems.
5. Pricing Stability - The group pricing has been relatively
stable and we have new individual plans that are the lowest on
the market.
Kaiser of California
Kaiser of California is likely the largest carrier in the
State. It's very different from the other carriers in that the
doctors/hospitals belong to the carrier. You must stay within
their network in most cases.
1. Plan Pricing - Kaiser has always been hard to beat in
terms of pricing and that will likely continue.
2. Network - This is what literally makes Kaiser a separate
model of health care altogether. Kaiser employs the doctors and
owns the hospitals. You must stay within the Kaiser network for
most situations. The availability of Kaiser really depends on
where you live. On average, they will have more facilities in
denser areas and less in rural area. There are areas where
there is no Kaiser network.
3. Flexibility - Kaiser has tried to expand their plan
options albeit within their facility network. Kaiser offers
some pro's in terms of flexibility such as electronic records
and facilitated processing but poses other concerns such as
greater medical service management.
4. Ease of Use - This is another facet of the Kaiser model
which is very different. In general, the day to day with Kaiser
can be pretty nice...kind of like a one stop shop. Where we
hear negatively from our clients is if you have a more serious
situation or want a wider breadth (say a specialist) of
providers. Kaiser is pretty solid when it comes to information
technology and the general administration with such things as
electronic records. Of course, there can be a significant
amount of "management" when it comes to medical services but
that's inherent in any HMO.
5. Pricing Stability - Pricing has always been advantage with
Kaiser and if pricing is your only concern and HMO is
fine...Kaiser will be hard to beat.
We focused on Aetna, Anthem Blue Cross, Blue Shield of
California, Health Net of California, and Kaiser since they are
some of the strongest
California health insurance carriers. There are many other
options on the market, but from our experience, they usually are
not advisable against one of the above mentioned four.
Related Aricles:
Current California market best values
Current Catastrophic health plan values
Health
Reform changes coming to California
Understand the California individual and family market
Understand the California group health market
|
