Team Management

How Do I Pick the Best Health Insurance Plan?

Gusto Editors  

Finding the health insurance plan of your dreams doesn’t happen overnight. It requires time, introspection, and a whole lot of research. From the menu of benefits being offered to how much your team will have to pay every month, there are a lot of elements you’ll want to explore throughout the process. In this article, we’ll show you how to become a health insurance matchmaker — so you can find a plan that makes everyone swoon.

Gusto makes payroll, benefits, and HR actually easy.

Your health plan cheat sheet

While trying to land a plan, you want to have a few key vocabulary words under your belt. Here’s what you need to know:

Type of plan:

What is it?Price of premiumFlexibilityIs a primary care doctor needed?Is a referral needed for specialized care?
HMOHealth maintenance organizationLowLowYesYes
PPOPreferred provider organizationHighHighestNoNo
EPOExclusive-provider planMediumHighFor some plansFor some plans
POSPoint-of-service planMediumMediumYesYes

The insurance company

This means Blue Shield, Anthem, Cigna, United, and others. Some carriers have wider networks brimming with more providers, while others have tinier ones.

Metallic tier

Each plan is tied to a tier that represents how rich the coverage is that’s being offered. In order of plans with all the fixings to least, they are: Platinum, Gold, Silver, Bronze, and Catastrophic. A platinum plan is like a huge sundae with the cherry on top; they have the highest monthly premiums, most in-depth coverage, and lowest out-of-pocket costs. For Catastrophic plans, it’s the complete opposite.

To up your metallic-tier savvy, take a look at the average medical cost each one covers. This is also referred to as the actuarial value.

  • Bronze: 60 percent
  • Silver: 70 percent
  • Gold: 80 percent
  • Platinum: 90 percent

Monthly premium amount

This is the total you and your employees will spend every month on health insurance. You and your employees pay this before taxes are taken out, which helps you both save a sizable amount.

Out-of-pocket costs

These costs are how much your team has to pay on their own.


This is the amount employees have to pay before their coverage steps in.

Actual benefits being provided

If benefits were a deli sandwich, this would be the filling. What services are actually being covered? From preventive care to acupuncture, this is what you’re paying for when all is said and done.

Your plan game plan

Throughout the decision process, here are some things to do that will help you zoom in on your perfect plan.

1. Ask your team what they want

It doesn’t matter how big or small your team is, the plan you select should be pliable enough to work for everyone’s health care needs. To find out what those needs are, consider sending out an anonymous survey through Google Forms or Typeform to get a better handle on what your team really wants. Some big questions to include are whether or not they prefer certain carriers, like Kaiser or Blue Shield, or specific plans, like HMOs or PPOs.

If you need a little more direction, flip through this guide that helps you find the benefits your employees crave.

As you’re surveying it up, remember that the Health Insurance Portability and Accountability Act of 1996, or HIPAA for short, bars you from asking employees about their personal health information. You also can’t ask carriers for their information without their explicit permission. However, you can definitely quiz your team about the benefits they have their heart set on.

2. During the shopping process, request a Summary of Benefits and Coverage

An SBC is a document that summarizes all the details of the plan you’re checking out. You request it from each insurance carrier so you can see what’s offered, what’s not offered, and how much you have to pay. It doesn’t matter if you’re just browsing or a full-blown plan participant, the insurance companies still have to give you a fresh copy.

If you’re presenting your employees with a few different options, make sure you hand out an SBC for each plan so they can know exactly what’s inside.

3. Be aware of all the rules out there

Health insurance ground rules: It’s meaningful, awesome, and it has tons of rules. The IRS, the DOL, the ACA, and other government bodies and legislation, all explain what is and isn’t acceptable when you provide your team with health insurance.

Learn how to stay on top of all the regulations with this free guide.

Okay, but what do most companies get?

Whether you work with a broker or not, the recipe for a great plan is something every employer should know about. Once you understand all the ingredients that go into worthwhile health coverage — and the rules that bring it to life — you’ll be ready to whip up a plan that’s pure perfection.

Updated: April 13, 2019


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