The news, research and trends impacting your workforce.  

How to Evaluate your Pharmacy Benefit Management Pricing Arrangement

How to Evaluate your Pharmacy Benefit Management Pricing Arrangement

Healthgram VP of Pharmacy Benefits exposes the opportunities for employers to save on pharmacy benefits management by understanding pricing, recognizing shortcomings in contracts and identifying PBM p...

How to Evaluate your Pharmacy Benefit Management Pricing Arrangement
Pharmacy Benefit Management: Shifting Focus From Discounts to Transparency

Pharmacy Benefit Management: Shifting Focus From Discounts to Transparency

To manage rising pharmacy benefit costs, employers are challenging the status quo. Consider these six ways for employers to break an outdated cycle and shift to a transparent pharmacy benefit manageme...

Pharmacy Benefit Management: Shifting Focus From Discounts to Transparency
How To Set Actionable Goals for your Onsite Clinic

How To Set Actionable Goals for your Onsite Clinic

Before launching your onsite health clinic, use these tips to define your company’s health and financial goals and use them to drive vendor evaluation and design custom clinic initiatives.

How To Set Actionable Goals for your Onsite Clinic
What Employers Should Know About Direct Primary Care

What Employers Should Know About Direct Primary Care

The health and financial risks of traditional healthcare are leading employers to embrace a new approach: direct primary care. In this article, Thold Gill, Principal of Wellness Coalition America, an...

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Why the future of healthcare starts with better data

Why the future of healthcare starts with better data

The future of healthcare begins with employers leveraging their workforce data to improve benefits offerings, reduce costs and help employees achieve better health outcomes.

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How employers are closing the gaps in healthcare

How employers are closing the gaps in healthcare

Employer-sponsored healthcare is full of contradictions. Employers pay more and get less. Employees value their benefits, but aren't satisfied. How are employers working to close the gaps?

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Room for improvement? How to evaluate this year's open enrollment

Room for improvement? How to evaluate this year's open enrollment

Another year, another benefits open enrollment in the books. So, how did you do? Before you turn to other business, it’s time to breathe, take stock of the process and evaluate what went well and whe...

Room for improvement? How to evaluate this year's open enrollment
Looking to improve the impact of your corporate wellness program? Prepare to get personal

Looking to improve the impact of your corporate wellness program? Prepare to get personal

Our experience and recent research on the subject finds that wellness program success relies on two important factors: health coaching and personalization. With these findings in mind, we’ve crafted ...

Looking to improve the impact of your corporate wellness program? Prepare to get personal
Real stories of health coaching and when wellness works

Real stories of health coaching and when wellness works

Research points to two major trends for healthy corporate wellness programs: customization and the power of coaching. While apps and trackers can help employees plan for healthy habits, when it comes ...

Real stories of health coaching and when wellness works
Providing benefits for an evolving workforce: what attracts and retains top talent?

Providing benefits for an evolving workforce: what attracts and retains top talent?

In addition to changes in education level, technical skills and culture expectations, a younger generation of workers brings a new perspective to the advantages of employer sponsored health insurance....

Providing benefits for an evolving workforce: what attracts and retains top talent?


Health Plan FAQs: Top employee questions and how HR can help

Health Plan FAQs: Top employee questions and how HR can help

 

It’s not uncommon for employees to have questions about their health plan. In fact, a 2015 Harris poll found that two in five insured Americans did not have a good understanding of the services actually covered under their healthcare plans.

To help, we worked with our member support team to assemble the top eight questions employees have about their health plans and answered them in language everyone can understand.

For more helpful employee communication tips, access our 2018 open enrollment guide.

                                                                                     

1. What’s covered under my health plan?

Your employer will provide you with a Summary of Benefits Coverage that summarizes the key features of the plan (or plans) offered. This document details the benefits covered under the plan, including what you can expect to pay for services, coverage limitations and exceptions. If you have questions regarding your Summary of Benefits, your Human Resource department is able to provide you with a copy and review with you.

Healthgram members may access their Summary of Benefits through their Member Portal and ask any questions through the online customer service tool or over the phone.

 


Related resource: 10 must-know health insurance terms


 

 

2. How do I know who is covered under my plan?

The best way to understand who is covered under your plan is to review which plan selection you are currently enrolled in. If you have specific questions about coverage of a spouse or dependents, you can review your plan information in your Member Portal, call your Healthgram Advisor or speak with your HR department.

 

 

3.  How long are dependent children allowed coverage under a health plan?

Dependent children are typically allowed under the plan until they turn 26 years old, but plans can vary so check with your HR for more accurate information.

 

 

4. Once I am enrolled in a health plan, can I make changes to it? 

If you would like to make any changes to your plan it needs to be completed during your company’s open enrollment period. These changes may including adding or removing dependents (spouse, children) or changing the plan you are currently enrolled in if your employer offers more than one plan option. Outside of Open Enrollment, however, changes are only allowed when there is a Qualifying Life Event.

 

 

5. What is considered a Qualifying Life Event?

According to Healthcare.gov, a Qualifying Life Event includes the loss of existing health coverage including job-based, individual, and student plans, losing eligibility for Medicare, Medicaid, or CHIP, and turning 26 and losing coverage through a parent’s plan. Household changes, such as getting married or divorced, having a baby or adopting a child or experiencing a death in the family, also count as qualifying events. To know exactly which qualifying events are included in your plan, review your plan document or contact HR.

 

 

6. What is the difference between an in-network and out of network provider?

Your insurance company has partnered with specific networks to provide you with doctors, facilities and providers that would be considered in-network. The specific network has negotiated discounts with this group of medical professionals, so charges in-network should always be lower than those out-of-network. Out-of-network providers can end up being significantly more expensive and you may be responsible for the full amount charged for that visit. Healthgram makes it easy to search for in-network providers using your member portal.

 


Related resource: How human resources teams can help lower out-of-network utilization with effective communication


 

 

7. Are there ways to save on health care expenses?

Understanding your plan is the key to managing your health care expenses. The following four tips can also help you become an informed healthcare consumer and in turn can help you save on healthcare related spend.

  • Use an in-network provider for any medical treatment you receive.
  • Compare costs of procedures before seeking care. The cost for the same health care service can vary by 200 to 500 percent depending on where care is sough. If you’re a Healthgram member, contact your Advisor for guidance. Other sites such as Healthcare Bluebook are a great place to start.
  • Know your prescriptions. If your prescription has been on the market for a while, often times there is a generic version that has the same active ingredients but on average can cost 80 to 85 percent lower than the brand-name product. Always ask your doctor if a generic is available for the drugs you are prescribed.
  • Know where to go when you need care. You can curb your health care spending by avoiding the most expensive kinds of care, such as emergency care, when possible. Unless you are facing a life-threatening problem such as chest pain or major trauma, you may be able to seek care at an urgent care facility or by making an appointment with your Primary Care Doctor.

For more money-saving tips, start with this blog post.

 

 

8. How do I know if I am supposed to go the ER, Urgent Care or make an appointment with my PCP?

Always go to the ER for emergency situations, like a suspected heart attack or a broken bone. For non-life threatening health conditions, a trip to urgent care is usually more cost-effective, as there is a significant cost difference between the emergency room and urgent care. If the problem occurs during your primary care doctor’s regular office hours, call first and make sure you’re headed to the right place. Sometimes your regular doctor can squeeze you in on the same day.

 


Related resource: ER, Urgent Care, or PCP? How to Know Where to Go


 

 

Healthgram helps thousands of employees navigate the ins and outs of their health plans with the goal of creating more empowered and engaged consumers. Contact our team to learn how we can help you save on healthcare costs and create an experience employees love.

 

CONTACT US

 

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