Insurance Plan Options for ASC Staff: 3 Plans to Consider

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Finding the right employee insurance plan depends on the size of your ambulatory surgery center and demographic of staff members participating. Businesses today are either choosing to self insure or offer low- and high-deductible health plans. However, multiple options should be available.


"Most ASCs offer at least two options for their employees," says John Merski Jr., executive director of human resources at MedHQ. "If a company is offering just a single healthcare option, they are limiting options for their employees. The two options at minimum should be the low- and high-deductible plans. That will help their employees be more informed consumers in the future."

Here are the pros and cons of each option, and what employees should consider when they are deciding on each.

1. Low deductible PPO plans. The more traditional low deductible PPO plans are ideal for employees who may have large medical expenses and need a high amount of coverage throughout the year.

"Those that have children, families or who are sickly tend to take the PPO offerings because they have a lower deductible," says Mr. Merski. "It costs more in the premium, but the deductible is lower and they can plan accordingly. However, if the employer pays the same amount for both plans and the out-of-pocket payroll deduction is the same, everyone will take the low-deductible plan."

Those with modest to few health issues who are just looking to cover annual check-ups will likely benefit more from high-deductible plans.

2. High deductible health savings accounts.
The more common high deductible plan today is health savings accounts, which allow the employee to set money aside in their own account and withdraw funds when necessary. Usually, these accounts are closer to $1,500 to $5,000 individual deductible level plans.

"If you have young healthy employees, a lot of the groups will choose HSA plans because they don't visit the doctor as much," says Mr. Merski. "They can stockpile money for the time when they do get ill. These plans also keep costs under control to some extent."

HSAs transfer savings from year to year as the funds accumulate. The high deductible plans have lower rates because the employer takes on more risk.

3. Self-insured plans.
Most ambulatory surgery centers will not have self-insured plans because they don't have the volume of employees necessary to mitigate risk. A self-insured plan is usually for companies with populations in excess of 75 or more employees.

"If you have a very high risk employee population that has a considerable amount of healthcare issues, going to a self-insured plan generally don't make it," says Mr. Merski. "The expense would be enormous and the resource limitations would place considerable burden on the  ASC. They should consider the fully insured plans instead because they are mixing with larger groups and the insurance company is taking some of the risk."

Self-insured plans are usually cheaper than fully-insured plans because the employer doesn't have to share risk with insurance companies; on the other hand, the liability does pose other risks for their employees under the self insured plans and most ASCs choose not to use resources in this way.

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