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Look under the hood before you buy

With group health insurance coverage, an employee's health catastrophe shouldn't have to turn into a personal financial catastrophe. After all, that's what health insurance is for.

With your help, employers can find the right deductible, benefit package and employee contribution to balance their premium. But when comparing lower premium plans, beware of hidden fees, benefit caps and coverage gaps that can cause employees trouble down the road.

Absolute dollar limits

  • Look out for benefit caps on durable medical equipment, air ambulance, imaging and prescription coverage. Think of how a $5,000 limit on air ambulance service billed at $17,000 could leave anyone gasping for air. Providence Health Plan does not limit these services.
  • Point out how each plan handles preventive care. Providence Health Plan follows evidence-based guidelines on the frequency of routine screenings—but no absolute dollar limits on plans other than HSA plans.

Absolute benefit limits

  • While benefit limits on some services such as physical therapy and skilled nursing care are common, watch out for plans that limit the number of doctor visits or other routine services before employees are hit suddenly with deductibles and coinsurance.
  • Look for copays per screenshot on MRI exams and other hidden fees used to recoup premium discounts on the back end. Providence Health Plan benefits are transparent and straightforward.

Providence Health Plan provides financial security

  • Remember that with Providence Health Plan, copayments go toward the out-of-pocket maximum. This includes office visit copayments to physicians, urgent care, lab and x-ray, and much more.
  • Employees enjoy fourth-quarter carry-over on deductibles with Providence Health Plan (excluding HSA by IRS rules). Even if employees meet their entire deductible in the fourth quarter, Providence credits them for the following year.
  • Many everyday services (office visits, for example) are still not subject to the deductible. As more carriers are shifting these services and applying the deductible, it’s good to remember that common services and preventive care are still comprehensive with Providence.
  • On out-of-plan benefits, Providence Health Plan pays UCR at the 90th percentile, higher than many competitor plans using contracted or Medicare allowable rates.

We're here to help

When you partner with your Providence Health Plan account manager, we can help your client get to an affordable premium without sacrificing their employees' financial security. We offer a variety of fully insured plans and administration for self-insured plans. But above all, we provide peace of mind.