A health-plan comparison with incomplete cost measures
An employer is considering a lower-premium health option for a dispersed workforce. The proposal uses a narrower network and separate prescription provisions, but the comparison shown to leadership includes only payroll premiums. Several employees use providers near a remote worksite that are not clearly represented in the directory. In a separate hypothetical claim example, the allowed charge is twenty-five hundred dollars, five hundred dollars of deductible remains, and employee coinsurance is twenty percent after that deductible. No maximum or other provision affects that example. A familiar insurance company will administer the proposed self-funded arrangement, and some managers assume its name means the employer has transferred all claim risk to an insurer.
1. What does the employee pay in the hypothetical claim?
Read the worked answer
Apply the five-hundred-dollar remaining deductible first, leaving two thousand dollars. Twenty percent coinsurance on that remainder is four hundred dollars, so the employee pays nine hundred in total under the stated assumptions.
2. What should the broader proposal review clarify?
Read the worked answer
Compare access, prescriptions, employee cost-sharing and relevant total costs alongside premiums. Verify local network availability and explain that a branded administrator does not establish fully insured financing. Review retained claim risk and any stop-loss terms separately.