Plan Renewal Checklist

Do you have a plan when it comes to renewing your health plan? You should. Renewal time presents a great opportunity to assess the overall health of your plan – what’s working, what’s not, and what you can change in order to save money, stay in compliance, or provide the benefits your employees most need. Here’s a quick checklist to get started:

  • Check compliance status.
    This should be relatively easy this year. Most of the new regulations related to the Affordable Care Act have already been phased in, and your plan should already be in compliance. Key changes coming up:

    • Out-of-pocket limits:
      For 2016 plans, maximum out-of-pocket limits will rise to $6,850 for individual-only coverage and $13,700 for family coverage. (Remember, limits were just $6,600 for self-only coverage and $13,200 for family coverage in 2015.)
    • 1094/1095 reporting:
      In early 2016, most self-funded plans will be required to file these New forms to comply with the cheap jerseys individual and employer mandates. You should already be tracking employee data in order to be ready to complete these forms. A quick refresher is available here. (link to February bulletin)

    • Prescription drug benefits:
      Plans may no longer have a separate out-of-pocket limit for prescriptions; medical and Rx must be rolled together.


  • HF-ENewsletter-1-Pic-01Review precerts and overall coverage.
    One of the benefits of a self-funded Compliance plan is the ability to determine precisely what your plan will cover. Although there are standard recommendations for precerts to require and procedures and care to cover, renewal is a good time to review these lists carefully with your cheap nba jerseys employee population in mind. For instance, you may choose to add coverage for certain elective procedures, or add or drop precerts for certain minor procedures.
  • Update prescription benefits.
    Prescription costs continue to rise and are a growing expense within most plans. You may dan wish to review copays and specialty utilization. To control costs, some plans are adjusting the employee contribution; raising the copay or coinsurance for specialty drugs; or switching to a coinsurance model from a copay model.
  • Consider deductibles and out of pocket limits.
    Particularly if your plan is a generous one with low deductibles, you should review these levels with an eye to the future. The so-called “Cadillac tax” is scheduled to apply in 2018. To avoid getting penalized by this tax, you may want to consider raising your deductibles incrementally, to avoid a huge jump later.
  • Review out-of-network benefits.
    To help control plan costs, you can make changes that encourage plan members to use your provider network, with its Preparing highly discounted rates. Some plans are choosing to remove all out-of-network coverages; others are increasing the portion of the cost that the employee must shoulder. Other plans are choosing to pay a percentage of Medicare on out-of-network expenses, which also has the effect of increasing the employee’s responsibility.
  • Assess funding levels.
    As the cost of healthcare continues to rise, be sure your plan is fiscally healthy. Assess your reserve and see if it supports your claim activity for previous years. Review your employee contribution levels; cheap nba jerseys a good rule wholesale mlb jerseys of thumb is to split the cost roughly 50/50 between employer and employee. If your plan relies too heavily on employer contributions, it is time to consider raising the employee contribution, either by raising deductibles or requiring employees to pay more of the premium cost.
  • Plan a renewal summer meeting early.
    Meet with your consultant and/or your HealthFirst account manager about six months before your effective renewal date, to allow plenty of time to make any adjustments V to your plan. If you have other needs or requests – for instance, you’d like to add a wellness program, a smoking cessation benefit, or additional disability coverage – just ask! It’s your plan; HealthFirst will help you create exactly what you want to offer.