As employers across the region look at group health insurance plans over the next few weeks, they need options. And that’s just what the Fort Wayne-based nonprofit insurance company PHP of Northern Indiana offers.
“We don’t feel there’s one size that fits all,” said Ross Hensley, senior account executive for PHP.
That’s why PHP offers three health insurance funding options and works with prospective clients to find the right employee benefits plans. PHP does not offer individual plans nor Medicare supplement plans, however offers dental, vision, pharmacy, life and disability products.
Founded by a group of doctors in 1983, PHP now offers services to companies with as few as two employees to those with more than 2,000.
Almet Inc, which has 63 employees at its steel fabrication plant in New Haven, has partnered with PHP since May 1, 2018. “We selected PHP based on their willingness to build a long-lasting relationship,” said R.J. Greim, Almet operations manager. “PHP offers a large network of medical providers we feel is beneficial to our employees.”
PHP offers three basic categories of health care products, the first and lowest risk for the employer being Fully Insured Plans. As Hensley explained, employers pay premiums to PHP, effectively pushing the financial risk onto PHP. Employers have the security of knowing their set monthly premium won’t change unless they hire more employees.
Employees typically pay a portion of the monthly premium and are responsible for deductibles, co-payments and coinsurance as outlined in the policy.
PHP’s full-risk offerings include Health Maintenance Organization, Point of Service and Qualified High Deductible Health Plans. Qualified High Deductible Health Plans, as the name implies, have significantly higher deductibles as well as lower premiums, but still cover employees and their covered family members when faced with catastrophic medical costs.
When helping companies make a decision on health insurance, PHP listens to employers’ needs and priorities. Are they looking for a health insurance plan that will wow prospective employees in the hopes of attracting and retaining talent? Or are they concerned about cash flow, or the bottom line?
They also meet with employee groups to ascertain their wants and needs.
Almet went with a fully insured plan for their employees. “When we shopped our plan in the spring of 2018 we didn’t want to sacrifice any plan benefits we currently had in place,” Greim said. “PHP helped us maintain our health insurance benefits for premium pricing that fit our budgetary needs.”
Companies willing to take on some financial risk can opt for a Self-funded Plan. “Rather than paying premiums to an insurance carrier the employer pays claims, directly,” Hensley said. “They’re taking on risk.”
The benefit to the employer is more control, lower taxes, cash flow flexibility, fewer regulations and increased plan options. Rather than continually, month after month, paying fixed premiums to an insurance company the company can pay for the claims as they come due.
PHP offers self-funding administrative services such as paying claims and providing a network of doctors and facilities. Self funded companies have more flexibility in designing their own health care plan based on their values, budget and strategic planning objectives. Plus self-funded plans are exempt from state insurance laws, so employers have more control over where their claim dollars are being spent.
PHP’s third product, LEVEL Solutions Plans, “is a hybrid of self-funded and fully insured plans,” Hensley said. LEVEL Solutions can provide additional savings to employers through surplus refunds while eliminating cash flow uncertainties.
Employee satisfaction is key
Keeping health insurance costs down is imperative to an employer’s bottom line, but providing good, reasonably priced health insurance is also imperative to employees’ sense of well-being. Greim believes Almet — through its association with PHP — has achieved that goal. “Our employees have enjoyed the relationship with PHP,” he said. “If an employee has a question concerning their benefits they can contact PHP directly and quickly get the information they need. PHP has also assisted Almet in creating employee wellness events in which employees have opportunities to learn more about how to improve their own health.”
Greim also believes when employees or their family members are injured or sick they shouldn’t have to stress about insurance coverage. “If one of our employees finds themselves in a situation where they need to use their health insurance coverage, we want them to have confidence in their plan benefits,” he said. “Our provider, PHP, helps us meet that goal.”
But security is not the only thing employees want from their health insurance providers. “What I hear ... employees are looking for something different,” Hensley said.
PHP includes several services that focus on employee well-being and convenience like 24/7 CALL-A-DOC telephone and or video service, a 24 hour nurse line, wellness programs and member discounts.
Keeping costs down
Medical costs rise every year, and it is PHP’s responsibility to balance an employer’s business objectives with afford-ability. Hensley said “typically medical insurance is the next expensive line item (in a company’s budget) except for salaries.”
So PHP has a medical management team comprised of doctors, pharmacists and nurses who look at individual members’ medical plans to assess if they’re being treated with the right drug or procedure. They also look for ways to economize, such as suggesting a generic drug or an alternate, less-expensive procedure. PHP’s doctors often confer with the member’s doctor to find an agreeable solution. “We want to have a partnership in maximizing benefits available to members and keeping members healthy,” Hensley said.
Flexibility is key to PHP’s success, no matter its clients’ size or priorities. “There is no silver bullet,” Hensley said. “Each group is different. We help design an employee benefit program around their needs.”