Penn-Ohio Regional Health Care Alliance

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Penn-Ohio Regional Health Care Alliance
The Insurance Dollar
Breaking Down The Costs Copays Deductibles Coinsurance

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The Insurance Dollar Cost Sharing Methods


Copay - Designed to offer reimbursement on high frequency/low severity costs.
Deductible - Designed to offer reimbursement on high severity/low frequency costs.
Coinsurance - Designed to maintain insured's "engagement" in costs.
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The Insurance Dollar
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The Insurance Dollar
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The Insurance Dollar
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The Insurance Dollar
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The Insurance Dollar
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The Insurance Dollar
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The Insurance Dollar
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The Insurance Dollar
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The Insurance Dollar
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The Insurance Dollar
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The Insurance Dollar

• Integrating Employee Engagement Through HRA's
• Employer offers "High" Deductible Plan with no
  employer funding of deductible.
• What Happens?
• Employer sees immediate cost savings.
• Employee see the actual costs of healthcare
  (becomes a gatekeeper)
• Employee bears the "first dollar" costs up to
  the deductible.
• With Coinsurance, "out of pocket" maximum is
  also important.
• Depending on market environment, may or may not
  be a competitive benefit package.

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The Insurance Dollar

• Integrating Employee Engagement Through HRA's
• Employer funds a portion of the deductible.
• What Happens?
• Employee sees the actual costs of healthcare
  (becomes a gatekeeper)
• Employee Rollovers have a savings effect on
  some employees (No use it or lose effect).
• Employer is in the insurance business (Takes
  Risk/Reward)
• Opportunity to build common goals.

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The Insurance Dollar

• Integrating Employee Engagement Through HRA's
• Employer funds a portion of the deductible.
• What Happens?
• Employee sees the actual costs of healthcare
  (becomes a gatekeeper)
• Employee Rollovers have a savings effect on
  some employees (No use it or lose effect).
• Employer is in the insurance business (Takes
  Risk/Reward)
• Opportunity to build common goals.

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The Insurance Dollar

• Integrating Employee Engagement Through HRA's
• Employer HRA funding affects more than the HRA
  Balance.
• 90/10 ER/EE Split Does this put enough of the
  employees skin in the game to affect behavior?
• 50/50 ER/EE Split
• 10/90 ER/EE Split Does this offer enough of the
  Y/Y savings opportunity to affect behavior?

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The Insurance Dollar
Open Dialogue
Penn-Ohio Regional Health Care Alliance