ALWAYS A GOOD QUESTION
Connie runs a non-profit with five employees, four of whom are covered by what most would think is a generous health plan; i.e., one that is HSA ‘qualified’, paying 100% after a $2,800 deductible. Her
employees pay just 10% of premium.
BTW, her renewal is just around the corner and it's a modest + 4.7%.
Here’s the rub.
Connie’s plan cost
$76,639 last year and she’s in hiring mode.
“OMG Jon, I’ll hit $110K this year! Can’t we join some kind of ‘pool’ and get a better deal?”
The answer to this all too frequent question stares at us every time we look at an insurers’ Explanation of Benefits (EOB). In Connie’s case, one was conveniently right on her desk:
“Look at the Health System charges for your surgery; $235,000 discounted to $108,000. Do you think it was your little group of four that negotiated that ‘deal?’
“Then consider the premium increase warranted by a 141% loss ratio, had you not already been in a pool.”
There’s no satisfaction in delivering that dose of deflating reality.
Not to mention the better question is, why with all their consolidations, Mega Health Systems’ costs never scale downward.
