Health Plan Design

Plan Design Ideas: Tackling cost-sharing complexity and specialty care

New technologies and approaches to care have made plan design choices more complicated than ever before. But ignoring your options may lead to serious consequences.

From member confusion to limited care access to surprise bills—top benefits leaders are increasingly working with their partners to evaluate new and interesting plan design ideas that address common health plan issues.

We’ve compiled a list of some of the most innovative plan designs options out there today—each with their own pros and cons.

01. Bring back the co-pays.

How many times a year do you have to explain “co-insurance” to your employees? Non-flat cost-sharing arrangements can be confusing and frustrating to members, especially as it remains difficult to know the true cost of a service in advance.

Solution? Use flat copays across your plan design to make things easier for your members.

PROS

  • Easier for members to understand
  • Simple to explain and develop communications
  • Easier for members to budget for upcoming expenses

CONS

  • Members lose the nudge to choose more cost effective options
  • Converting co-insurance levels (like 20%) to large copays (like $500) may cause member sticker shock
  • Unlike coinsurance, copays don’t provide the plan with built-in inflation resistance

02. Treat ‘out’ as ‘in’ where appropriate.

For certain types of specialty care, there aren’t enough in-network providers to appropriately serve the population. Navigating out-of-network rules and cost-sharing can be an impediment to members getting the care they need.

Solution? Where appropriate, change your plan design to apply in-network cost-sharing rules to out-of-network providers.

PROS

  • Increases access to providers and gives members the flexibility they need to find a provider that truly meets their needs
  • The provider/patient relationship can stay intact—even with network changes—increasing continuity of care
  • Increased access to necessary care can drive down medical costs over the long haul

CONS

  • Increased care utilization may increase short-term healthcare costs
  • Making it easier to access out-of-network care can undermine the value of network discounts
  • Even if cost-sharing differences are offset, members can still be intimidated by the process of submitting an out-of-network claim with traditional carriers

Want more bold health plan ideas? Download our whitepaper, 8 Big Health Plan Ideas, to learn more and see if it’s time to make changes to your strategy.

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eBay Red Bull
Activision Blizzard
eBay
Zendesk Counsyl
Trace3 DataSafe
eBay Red Bull Activision Blizzard Zendesk Counsyl Trace3 DataSafe