Small businesses in Oregon are truly the soul of our state’s economy. These organizations encompass every industry and provide the majority of jobs for Oregon residents. These businesses face unique challenges, particularly when it comes to offering employee benefits, which can be confusing and expensive for smaller-scale operations.
Offering good employee health benefits is critical to attracting and retaining talent, so facing that confusion and cost can’t be avoided. Thankfully, there are ways to navigate the experience that lessen the headache and can help you save money. This article covers the pathways to getting insurance, how to uncover the needs of your workforce, how to compare options, and ways to manage the cost.
*Need a comprehensive small business owners’ health insurance guide in Oregon? Check out our full eBook here.
Before you get started
Take some time to understand the pathways to getting health insurance coverage in Oregon. Three ways to get small business health benefits are:
- Association health plan: An AHP is a type of group health insurance, such as OBI HealthChoice, that allows smaller employers to access the health insurance savings normally associated with large group plans.
- Small group market: This term refers to the insurers and plans that offer insurance packages to small employers. In most states, these are businesses with 50 employees or fewer.
- Direct market: The direct market involves businesses directly purchasing health insurance plans from insurance companies or brokers without the need to join a larger group or pool of businesses.
Step 1: Evaluate your workforce and demographics
First, understand federal or state obligations if you have more than 50 FTE, as companies exceeding 50 employees are required to offer health insurance. Next, take a holistic look at your team and their demographics. Consider the unique needs of your workforce and what type of coverage will best address those needs.
Discuss needs vs. preferences
The people you see every day can tell you what they need better than anyone. Consider hosting an internal roundtable to discuss.
Needs: What do your employees need most in terms of coverage? Things to keep in mind include the average employee age, whether your employees have families and children, and the type of work your employees do. Employees without families may not need the level of benefits desired by employees with families, but remember that younger employees who stay with your team long term will have evolving needs as years pass.
Preferences: What do your employees value most when it comes to coverage? Give your team members a chance to share what is most important to them when it comes to health insurance. You may find that doctor choice is really important, or perhaps the team’s biggest priority is to save money. Those may lead to different options (see our full eBook for a breakdown of different types of small business health plans like PPOs and HMOs). Keep in mind all employees will likely be interested in seeing what your business can offer, so bring all team members into the conversation.
Step 2: Explore Your Options
Now, it’s time to dive into plan options and begin making your policy selection. As you research individual plans, make sure to review:
- Details of plan documents: Analyze the essential documents of each policy you’re considering. Go over the summary of benefits and coverage (SBC) and the evidence of coverage (EOC). This information will show what is covered under the plan, how much deductibles and out-of-pocket costs are, and what you and the employee will pay for premiums.
- Costs: Go over potential costs carefully so there are no surprises once you select a policy. Considering premiums, deductibles, copays and out-of-pocket costs, how much would a person potentially have to pay per year?
- In-network vs. out-of-network care: How large is the in-network pool of health care providers available on the plan? Be sure to understand if specific plans require people to choose a primary care insurance provider in order to be covered. Does the policy cover any out-of-network care?
- Emergency and urgent care coverage: No one likes to think about a crisis, but medical emergencies do happen. What does the plan offer in this area? Are out-of-network restrictions waived in case of emergency?
- Reputation: There’s no need to suffer with a subpar plan. What can you find out about the customer service and general reputation of the insurance carrier and policy? See if you can solicit recommendations from similar businesses.
- Prescription drug coverage: Some policies require patients to use specific pharmacies to fill prescriptions, which may or may not be convenient for your employees. Some employees may have very specific medication needs and will want details on prescription drug coverage. There may be restrictions on the types of prescriptions covered and the frequency of refills.
- Additional programs: Some of your employees will likely want dental and vision coverage, which tend to be add-on plans, so you’ll want to price these out as well. Does the policy offer benefits like employee assistance, wellness programs or preventative care coverage?
Step 3: Plan to manage costs while maximizing care
Affordable health insurance for small businesses does exist, but ultimately, your cash flow will dictate what you can offer. Look for ways to balance your team’s preferences and needs with actual, available funds. Without making any shifts or adjustments, what is your available budget? If it’s less than you would need to offer your employees’ preferred coverage, investigate possibilities for shifting funding around in the business. If you have fewer than 25 full-time employees, know that you may also qualify for Oregon’s small business tax credit.
As you assess your budget, a helpful approach is to create a priority list of your employees’ needs and aim to offer a plan that at least covers the most critical items. This picture will become clearer as you explore insurance options. As small businesses group health insurance plans can be opted into at any time, you can always change coverage as your business grows and evolves. Working with a knowledgeable agent can help with this process.
Tips for getting the best coverage and care for your employees
- Pick a trustworthy agent/broker to help you negotiate the best plans for your business during the initial setup period and when your renewals arrive each year.
- Look to lock in a health plan that offers a wellness program or have your HR team create one. Wellness programs can incentivize employees to take advantage of their plan benefits and be proactive about their health, both of which help with negotiating premiums during your renewal period. Encouraging your employees to take care of their health is also just good sense for them, your business and your community.
- When finalizing your plan, consider the level of cost-sharing (things like deductibles, copays, coinsurance, etc.) A higher level of cost-sharing could mean a lower premium that you, as the employer, will need to pay. However, passing that on via cost-sharing to employees can affect their ability to afford needed and preferred care.
Choosing the right health plan for your small business is a big decision. Evaluating your options can take time, but selecting the best plan will serve you and your business well for years to come. We hope this blog is a helpful resource as you move forward with finding a plan that fits you and your employees best.
As you explore plans, we’d love to talk to you about OBI HealthChoice and the benefits it can bring to your small business. HealthChoice is the Regence-powered plan created for OBI members and is designed to meet the unique needs of Oregon small businesses. As an association health plan, HealthChoice brings together small businesses across the state and enables them to enjoy the quality of plans available for large employers without scaling their employee counts to access better benefits or breaking the bank. You can learn more about HealthChoice here, or contact The Partners Group to get started:
The Partners Group
Zach Fritz, Employer Services Practice Leader
email@example.com • (503) 726-5755 | Text/Cell: (503) 290-4848
And for questions about membership in OBI, contact:
Joan Olivier, member relations director at Oregon Business & Industry