Employer Health Insurance Memphis TN

You have a lot of choice in deciding which services you want to cover. You will find, however, that the differences between the health plan one employer offers and the health plan another employer offers are more likely to be in the levels of reimbursement they offer than in the types of care that they cover. For example, if you look at 10 different employer plans from different parts of the country, they'll all cover surgery on an inpatient basis, but some may have 80 percent reimbursement above a $500 deductible, others may reimburse at 90 percent if a network provider is used and 70 percent if not, and still others may reimburse at 100 percent if the surgery is performed on an outpatient basis.

The big twelve. The expenses that you will find covered by almost every health care plan are:

• treatment of illness, disease, or accidents
• medical, surgical, exploratory, therapeutic, or emergency care
• inpatient hospital room, incidentals, and treatment
• outpatient surgery and treatment
• doctor's office visits and treatment
• nursing services
• diagnostic care, such as x-rays, MRIs, or blood tests
• prescription drugs
• dental, vision, or hearing care, if required due to an accident or injury
• pregnancy and childbirth costs
• durable medical equipment purchase or rental
• specialty care, such as that provided in the Intensive Care Unit or Cardiac Care Unit

Common exclusions. The exclusions that you'll find in almost every policy are:

• work-related injuries covered by workers' compensation
• services not recommended by a physician
• charges above those defined by the plan as reasonable and customary
• cosmetic surgery
• experimental procedures, drugs, or surgery

Mental health and substance abuse. Most states have laws that require insurance companies to include coverage for mental health and substance abuse. Generally, if those coverages are required in your state, they will be included as part of the standard policy and their cost will be re...

In recent years, several states have enacted small employer market reforms that are designed to enable small employers to obtain health insurance at rates that are lower than rates that have traditionally been available to them. The reforms include laws that guarantee renewals; that limit the extent to which your group's health status can be used to set rates; that provide basic, low-cost policies that do not include costly benefits that are mandated for standard policies; and that require insurers to make coverage available to you regardless of your employees' health condition. No two states have the same set of reforms. An insurance agent can give you more information about the specifics in your state.

In the Health Insurance Portability and Accountability Act of 1996 (HIPAA), Congress extended some of these state reforms to the federal level. As of June 30, 1997, insurers that offer health plans in the small business market cannot exclude any small business from coverage.

If insurers choose to offer plans in the small business market, they must offer the plans to all small businesses in that market. Thus, for example, an insurer cannot choose to drop your coverage because one of your employees develops a heart condition. To gain the protection of these federal rules, though, you must have at least two employees....