| It's a pretty straightforward program where | | | | having the dreaded higher premiums. |
| employees are offered and encouraged to use | | | | The other spectacular point of interest about the |
| the designated doctors who meet certain | | | | Premium program is that it acts as an educational |
| cost-efficient and quality standards. This allows | | | | tool for those who "opt-in" by showing them the |
| employers to offer workers competitive benefits | | | | real costs associated with health care coverage. |
| with higher incentives. For instance, workers who | | | | This is something not a lot of people realize, as |
| take advantage of the Premium program may | | | | they have been insulated for so long from the |
| opt for lower co-pay and co-insurance levels, but | | | | billing process. In addition, many health care |
| still get and enjoy quality health care. | | | | providers do not choose to share the actual costs |
| Employers get to choose from an a la carte type | | | | of services with the public. |
| menu that lets them know in advance how much | | | | What are the benefits of increased health care |
| to budget for their plan contributions. For example, | | | | consumer knowledge? It's a shift in attitude and |
| there are choices for emergency room co-pay | | | | patient behavior in how they utilize the health care |
| ranging from $100 to $150; urgent co-pay at $50; | | | | system, a change that is long overdue. The |
| and preventive care at 100 percent (not subject | | | | benefits for the employer are also long-term |
| to co-pay). | | | | health care savings. |
| The Premium program was developed in | | | | Here is how the program works - the nuts and |
| response to some amazing and somewhat | | | | bolts of it. Doctors and facilities are recognized |
| depressing statistics - those stats being that | | | | with stars - much like a hotel is starred for its |
| roughly one-half of all the patients needing medical | | | | services - for following national guidelines for cost |
| care actually get care that meets national medical | | | | efficient and quality care. Doctors that meet both |
| standards. | | | | criteria get two stars. Others who meet quality |
| Other attractive features the employer may | | | | standards are awarded one star. It's pretty easy |
| choose to offer are a family deductible at twice | | | | to look for the stars to find a physician you want |
| the individual rate, as well as a family | | | | to visit. |
| out-of-pocket maximum of twice the individual | | | | These stars aren't just handed out at random. |
| rate, and a lifetime maximum of $5 million. There | | | | They are handed out based on evaluations by |
| are other options an employer may choose from, | | | | The American College of Cardiology, The |
| but suffice it to say that it's a flexible program. It | | | | Ambulatory Care Quality Alliance, and The |
| has lots of potential to be a leader in the | | | | Agency for Healthcare Research and Quality. |
| workforce offering competitive benefits without | | | | |