In a study by Glassdoor about the benefits that matter most to employees, group health benefits took the top spot. They even ranked above both paid vacation time and retirement plans!
A few other interesting statistics point to this reality.
- 60% of employees said they would take a job with lower pay but better benefits.
- 16% of employees have actually left a job or turned down a job due to the benefits offered by their employer.
And while group health benefits are important to your employees, they are also one of your major expenses. Group health insurance is usually the 2nd or 3rd largest operating expense after payroll for employers.
With this in mind, it’s evident that choosing your group health insurance carrier and plan are incredibly important decisions!
If you are located in the Pittsburgh area, you are probably familiar with both the UPMC and Highmark insurance carriers – the two largest local group health insurance carriers. But these carriers are not the only companies with skin in the game. Several national networks also provide coverage for employers in Southwestern Pennsylvania.
So, who are the major players in the group health market in this area? And what do they have to offer to your business?
As an Employee Benefits Advisor, I have worked with all five of the major group health insurance carriers that work with businesses in our area. And for a while, I even worked for one of those carriers. Over the past 25 years, I have made group health my business especially pairing clients with the right carrier.
In this article, I introduce the top five group health carriers and share the pros and cons of working with each of them. Let’s take a look at these five carriers:
- UPMC Health Plan
- Highmark BCBS
- United Health Care
Headquartered in Pittsburgh, PA, UPMC Health Plan is a non-profit group health insurance carrier owned by the University of Pittsburgh Medical Center. UPMC serves more than 3.9 million members. Its network, which is limited to Pennsylvania and some of Ohio, West Virginia, and Maryland, includes over 140 hospitals and 29,000 physicians.
- Own a hospital system
- Ease of use within their system
- Keep prices down when members use providers in their network
- Least expensive carrier for small group health insurance plans
- Members can only use providers in the UPMC network which is confined to a limited geographical area
- Members who spend significant periods of time outside of the UPMC network will be forced to use out-of-network providers at a higher price
Highmark is a local group health insurance provider that operates out of Pittsburgh, PA. An independent licensee of the Blue Cross Blue Shield Association, Highmark serves more than 5.6 million members in Pennsylvania, West Virginia, and Delaware. Highmark is also affiliated with United Concordia, The Highmark Foundation, HM Insurance Group, and Allegheny Health Network.
- Members have access to a nationwide Blue Cross Blue Shield network of providers
- Plans are available in tiers – some less expensive tiers allow members to use only Highmark facilities which include great options like Cleveland Clinic
- Higher level tiers allow members to also utilize the UPMC network of providers
- When a member needs specialized care, they have access to a nationwide network of specialists
- For those in Southwestern PA, members may not be able to use UPMC facilities if they have a lower tier of the Highmark products
- Highmark is more expensive than UPMC
Operating out of Minneapolis, MN, United Health Care is the nation’s largest for-profit group health insurer. United Health Care partners with more than 1.3 million physicians and health care professionals and contracts with over 6,500 hospitals and health care facilities in the U.S.
- Offers plans for both small and large groups.
- Offers HMOs and EPOs.
- Flexible options including dental, vision, and other specialty benefits.
- Operates very efficiently which reduces costs to members
- Takes an active part in claims management for their members.
- Members need referrals for services to help with cost control
Aetna was founded in 1893 in Hartford, CT. Aetna, a for-profit, national group health insurance carrier, is a subsidiary of CVS. This carrier serves around 22.1 million medical members with an additional 12.7 million dental members. Members have access to service in over 5,700 hospitals nationwide along with a network of over 700,000 primary care doctors and specialists.
- Very competitive in the large group health plan market
- Offers members a national network of providers
- Offers level-funded and self-funded programs for businesses
- Manages claims process closely and requires precertification for procedures and appointments
- Only offers self-funding options for small groups
- Does not participate in the ACA small group market in Pennsylvania
Cigna is a for-profit international group health insurance carrier. Cigna has providers in over 30 countries and jurisdictions. Cigna also has contracts with over 99% of pharmacies in the United States. Globally, they have over 17 million medical customers. They also have a large network of dental providers.
- Has a large national presence and an international presence as well
- Works well for large groups of 500+ employees
- Known for their high tech platforms and solid data analysis
- Takes an active role in managing their clients’ costs
- Keep their costs trends low – near the Consumer Product Index
- Self-funded programs can “rent” their network
- Not a big player in Southwestern Pennsylvania
- Very limited offerings for smaller businesses
Self-funding: The other group health insurance option
For many employers with 50+ employees, self-funding is the best way to long-term savings. Most self-funding plans engage with a group health insurance carrier to “rent” their network of providers.
Most employers think self-funding is too risky! This is generally because self-funding is not well understood by employers. Essentially, self-funding works the same way as traditional group health except that you have control over your plan.
Employers are often afraid that they will not have the resources to pay for their employees’ claims. This is often not true. And in the case that an employee has to file a catastrophic claim, self-funded plans purchase a stop-loss insurance policy to cover them.
Self-funded plans, while underused, are a highly effective group health option that allows the employer to reduce group health costs and seize control of their group health plan.
- Reduces overhead costs associated with group health insurance carriers
- Avoids state taxes and some government-mandated benefit requirements
- Gives employer greater control over plan options and claims management
- Assumes greater risk than simply using a group health insurance carrier
- Requires high-level administration or hiring a third-party administrator
- Requires purchasing a stop-loss insurance policy
Which group health insurance carrier is a good fit for my company?
Now that you’ve had an overview of the major group health players in our region, you’re probably wondering how to determine which network you might want to employ as your carrier.
Here are the considerations you will want to take into account before selecting a group health carrier:
- The size of their network
- Premium costs
- Types of products offered (i.e. PPO, HMO, POS, HSA, etc.)
- Electronic capabilities
- Local geographical presence
- Customer service excellence
- Claims management strategies
- Wellness programs
The carrier you choose will be dependent on the size of your company and your goals in these areas. Your Employee Benefits Advisor will look at each of these considerations to guide you to the best carrier for your business.
At Baily Insurance, we walk with our clients through a process to determine which group health insurance option carrier is best for their business. We also help our clients evaluate if self-funding might be the best option for them.
But our commitment to our clients involves more than directing them to the right carrier. Baily Insurance Agency is dedicated to helping our clients manage their costs and proactively addressing the causes of any group health premium increases.
If you are looking for an Employee Benefits Advisor to guide you in the decisions you need to make to determine the insurance carrier option that is best for your business and reduce your premiums long-term get in touch so we can schedule an introductory meeting.