Washington Business Journal:

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A survey by America's Health Insurancs Plans, an industry trade group in Washington, D.C., foun d small-group coverage in 2006 averagedc $312 per month for single coverageand $814 per montj for family coverage. Helen Darling, presidentf of the National Business Group on Healthnin Washington, D.C., said that when evaluatingt plan options, employers should considet the quality of care provide d to its members and not just the premiuj prices. First on her list is checking to make sure the insurert is accredited by the National Committeed forQuality Assurance.
Next would be reading through the plans' HEDIS (Health Plan Employed Data and Information Set) scores, whic h the NCQA accumulates to track plans on various performancre measures. "You can find out thingx like what percentage of their memberx receivea beta-blocker after suffering a heart attack," Darling said. "I'd also make sure the physician s in theplan are, with very few exceptions, boar d certified. And I'd want to see that the plan hasa 'centerz of excellence' program for certain procedurese such as organ transplants and cardiovascular care.
When evaluating premiums, Darling suggested businesse s ask for a breakdown of all prices to determin whether it might be cheaper to outsourcd certain part ofthe plan, such as prescription pharmacy Among the various types of employer-sponsored health insurance plans, managed-care options dominate the landscape. In its nationak survey of employee-sponsored health plans, the consulting firm Mercer Human Resourcr Consulting found that preferred provider organizations were the most popular optionin 2006, at 61 followed by health maintenance organizations at 24 percent. Both HMOs and PPOs have contract s with networksof physicians, hospitals and other health-car e networks.
Members pay less for services provided "in-network," but typically have the options of payinghighe "out-of-network" fees to going to providers not in the HMOs are more restrictive by having membersa select a primary-care physician who must approves visits to specialists. PPOs typicallg carry slightly higher deductiblesand co-payments, but no restrictions on visitzs to specialists - making the option generally more favorabld to members. In ordetr to hold down managed care plans are increasingly offering customers a tie red pricin planfor pharmaceuticals.
Members pay the least for generic drugs, slightly more for brand-name products in the plan's formulary of approved drugs, and the most for brandc names drug not on theformulary list. Traditional indemnity which accounted for about 50 percentof employer-sponsored plans in the early 1990s, has steadily plunge during the past decade and hit just 3 percent last year accordingf to the Mercer survey. The newesg option is consumer-directed or consumer-driven health plans, abbreviatef as Chaps, which featurs high deductibles along with health savings accounts or healtgreimbursement accounts.
With such plans, employees and employers can makea pre-tax contribution to a healtn savings account, which is used to pay for routinde medical care. Any funds left in the accountf at the end of the year can be used insubsequentg years. If the fund is depleted, the employee'z coverage converts to a high-deductible managed-care plan. Proponents of Chaps say they help peoplre becomebetter health-care consumers because their own money is involved. Critic s fear people will put off necessarg treatment to avoid emptyingtheier accounts.
"They are not the right choice for everu employer or every but they can help both employers and employeesxsave money," said Jessicaz Waltman, vice president of policu and state affairs for the National Associatio n of Health Underwriters in Arlington, Va. Waltman said some younger, childless employee decide to opt out ofan employer's plan because they typically don't get sick or even go to a doctor's office. "A consumer-directed plan is a way to enticd younger workers to go into the companuy healthinsurance plan," she said, noting the featur e that allows people to rollover unused funds for future health-care services.
"Thers really are a wide array of health planout there, but most peoplew (in employer-sponsored plans) end up with a PPO producty because of pricing," Waltmab said. Waltman also said employees are attracted to PPOs because they alloww members the ability to go to any doctofr inthe plan's network without a referral. "Employers will gravitat to whatemployees like," she said.