The Elite Eight
The Key Elements of a Quality Limited-Benefit
Health Plan
Limited-benefit health plans vary from bare-bones indemnity plans and discount cards to full coinsurance
plans with benefits that provide true value to customers.
Before you decide on the product that is right for your
client, make sure the plan has eight essential qualities:
Simple Plan Design: The plan design should be simple,
straightforward and transparent while still providing maximum value. All marketing communications and materials
should be in basic, easy-to-understand language without
insurance jargon and phrases.
Simple Enrollment Process: Enrollment should be easy
and hassle-free. Enrollment methods should include a
mix of live agents, automated phone system and web-based systems.
Network Access: Access to an expansive network with
deep discounts allows members to stretch their benefit
dollars. There should also be no out-of-network penalties. For a population that may be unfamiliar with
health insurance, the emphasis should be on educating
members about the value of using a network provider
rather than penalizing them for using an out-of-network provider.
Wellness Benefits: Building a relationship with a doctor
is a key to getting and staying healthy. Make sure the
plan provides coverage for annual wellness and well-woman exams. According to the National Institutes of
Health, the people who receive preventive care through
wellness exams were less likely (by over 10%) to contract
breast or prostate cancer or have cholesterol problems.
Hospital Benefits: Coverage for brief hospital stays is
essential. Quality plans do not have daily coverage maximums and should allow you to access your complete
benefit amount from day one.
Pharmacy Benefit: The pharmacy benefit should offer a
point-of-sale discount rather than a mail-in reimbursement.
Access to Health Information and Resources: The
ability to research and discover unique health information
to fit your personal needs is a large part of preventive
health care. Health information and resources should be
available in print literature, online and with customer
service over the telephone.
Access to health-related discount programs: A quality
plan should offer a variety of wellness information and
discount programs, helping members with weight loss,
tobacco cessation, chiropractic services, fitness/exercise
programs, vision services and more.
The value to employers that offer their employees limited-benefit health plans are improved recruiting, increased retention and reduced absenteeism and
presenteeism. This value proposition is even more important in today’s economic climate. Retaining the best
employees and making sure they can stay healthy and
productive is paramount for employers.
It is worthy to note that with an established record of
success across perceived “hard-to-reach” industries such
as restaurant, retail and hospitality, the limited-benefit
m arket continues to grow.
B ecome Part of the Solution
By including a limited-benefit
h ealth plan in your portfolio, you can
h elp address one of the country’s
m ost urgent social issues: the working
u ninsured. Increasing the availability of limited-benefit
health plans is a proven solution that gives workers with-
out access to comprehensive health insurance through
their employer or spouse the opportunity to take advan-
tage of affordable coverage designed to help them get
healthy and stay healthy.
According to the 2008 Census Bureau report, 45. 7 million people in the United States are uninsured and more
than 37 million of them are in working families. Many of
the working uninsured are in part-time or hourly positions and are struggling to pay just for necessities. Health
insurance is typically a low priority. A study by CIGNA
Voluntary found that, for these people, health insurance
ranked eighth in importance when it came to household
expenses, behind rent or mortgage, food, utilities, gas, vehicle maintenance, car payments and auto insurance.
The Kaiser Family Foundation found that 56% of the
working uninsured do not have access to coverage
through their employers. Limited-benefit health plans
are necessary for the working uninsured because, without access to health care, they are at an increased risk of
developing chronic health conditions. Without an ongoing relationship with a primary care physician, the working uninsured are the least likely to have access to
preventive measures that will keep them well, out of the
hospital and on the job.
The Importance of Communication
Limited-benefit health plans serve a population that
often has never had exposure to health insurance or
health care beyond the emergency room. During the
process of identifying a quality limited-benefit health
plan, it is important to consider customer communica-
tion strategies via enrollment and educational material.
Effective communications leads to a higher participation
rate and greater employee satisfaction with the plan.
Best practices in customer communication include:
• Simplified content in enrollment and marketing
material
• Creative enrollment strategies
