How Do I Know if I Have a Good Health Insurance Plan?

Gusto Editors

The road to amazing health care is paved with an amazing health plan. But how do you know if your plan is truly a diamond in the rough?

Generally, a solid plan has the exact flurry of benefits that your team is looking for. It’s also crisp on the compliance front so you can breathe easy knowing that you’re following the law.

To help you unearth a plan that is fueled by both of those characteristics (and more!), we’ve done some homework for you. All you need to do is keep scrolling.

What your health plan should cover

No matter what type of health plan you go with, you should expect the following things to be covered:

  • Doctor visits
  • Prescription drugs
  • Outpatient treatments
  • Hospitalizations
  • Maternity care
  • Preventive care, including mammograms and vaccines
  • Rehabilitation
  • Anything else that your employees use often

The last bullet point is important. If your employees use something like chiropractic care, make sure you find a plan that either covers the service or has a deductible that’s low enough so they can continue to get treatment.  When you present your team with their summary plan description, they’ll be able to find out whether the services they need are actually covered.

Legal goodness

The Affordable Care Act contains something called the “minimum value standard,” which states that if you have 50 or more employees, your plan needs to cover, on average, at least 60 percent of each person’s medical expenses.

But the best health plans include even more than that. When a plan pays for all the essentials, like doctor visits to primary care physicians and specialists, outpatient treatments and more, your employees’ gratitude will go through the roof.

Group goodness

If you’re purchasing a group health plan, you’re one step ahead, because it has already been vetted and approved. Paying your team back for individual plans can lead to fines of up to $100 a day (up to $36,500 a year) for every person you reimburse.

Things start to get tricky when your team starts buying individual plans, but you can prevent that from happening by giving them group coverage. Read more about the difference between the two plans here.

When you’re studying your insurance plan options, make sure the plans you’re surfacing can tick off everything on our checklist. You may want to think about offering even more benefits to keep your team feeling good and your hiring engine going strong. So spin the wheel, pick a great plan, and watch your team win.

Gusto Editors Gusto Editors, contributing authors on Gusto, provide actionable tips and expert advice on HR and payroll for successful business management.
Back to top