The Business Review (Albany):

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A survey by America'se Health Insurance Plans, an industry trade grou p in Washington, D.C., founed small-group coverage in 2006 averaged $312 per mont h for single coverageand $814 per month for family coverage. Helen Darling, president of the Nationall Business Group on Healtghin Washington, D.C., said that when evaluatinvg plan options, employers should consider the qualit y of care provided to its members and not just the premiumn prices. First on her list is checking to make sure the insuredr is accredited by the Nationalo Committee forQuality Assurance.
Next would be readinyg throughthe plans' HEDIS (Health Plan Employer Data and Information Set) scores, which the NCQA accumulates to track planx on various performance measures. "You can find out thinga like what percentage of their membersw receivea beta-blocker after sufferinv a heart attack," Darlingy said. "I'd also make sure the physicians in theplan are, with very few board certified. And I'd want to see that the plan hasa 'centersx of excellence' program for certain procedures such as organn transplants and cardiovascular care.
" When evaluating premiums, Darlinvg suggested businesses ask for a breakdown of all pricees to determine whether it might be cheaper to outsource certainn part of the plan, such as prescriptio pharmacy benefits. Among the varioues types of employer-sponsored health insurance managed-care options dominate the landscape. In its nationall survey of employee-sponsored health plans, the consultiny firm Mercer Human Resource Consultinyg found that preferred providerorganizations (PPOs) were the most populaf option in 2006, at 61 percent, followed by health maintenance organizations (HMOs) at 24 percent.
Both HMOs and PPOs have contractss with networksof physicians, hospitals and otherd health-care networks. Members pay less for services providex "in-network," but typically have the options of payinghigher "out-of-network" fees to going to providersd not in the network. HMOs are more restrictive by havinf members selecta primary-care physician who must approve visitds to specialists. PPOs typically carryg slightly higher deductibles and but no restrictions on visits tospecialists - making the optionn generally more favorable to In order to hold down premiums, managed care plans are increasingly offering customers a tie red pricingb plan for pharmaceuticals.
Members pay the least for generic slightly morefor brand-name products in the plan's formularyy of approved drugs, and the most for brand names drug not on the formularuy list. Traditional indemnity which accounted for about 50 percentof employer-sponsorede plans in the early has steadily plunged during the past decads and hit just 3 percent last year according to the Merced survey. The newest option is consumer-directed or consumer-drivej health plans, abbreviated as Chaps, which featur high deductibles along with health savings accounte or healthreimbursement accounts.
With such plans, employees and employerd can makea pre-tax contribution to a health savingx account, which is used to pay for routine medicakl care. Any funds left in the account at the end of the year can be used insubsequenrt years. If the fund is depleted, the employee's coverage converts to a high-deductible managed-care plan. Proponents of Chap s say they help people becomebetterd health-care consumers because their own money is Critics fear people will put off necessary treatmenf to avoid emptying theidr accounts.
"They are not the right choice for evergy employer orevery employee, but they can help both employers and employees save money," said Jessica Waltman, vice president of policgy and state affairs for the Nationakl Association of Health Underwriters in Va. Waltman said some younger, childless employeea decide to opt out ofan employer's plan becausre they typically don't get sick or even go to a doctor's "A consumer-directed plan is a way to entices younger workers to go into the company healthy insurance plan," she said, notingv the feature that allows people to rollovee unused funds for future health-care services.
"There really are a wide arra of health plans out but mostpeople (in employer-sponsorede plans) end up with a PPO producy because of pricing," Waltman said. Waltmajn also said employees are attracted to PPOs becauses they allow members the ability to go to any doctord inthe plan's network without a referral. "Employerws will gravitate to whatemployees like," she