Information to Ask For

In order to best evaluate the plans that you are considering offering to employees, you should ask the companies to provide you with the following information:

• a list of participating physicians or clinics that are located near your employees
• a list of hospitals and outpatient clinics that are near your employees
• an explanation of the quality control measures they use to screen for quality medical providers
• in your chosen geographic area, an adequate number of licensed primary care givers
• in your chosen geographic area, an adequate number of licensed specialists
• statistics on patient satisfaction
• a list of other employers in the area that contract with them
• a copy of a sample agreement they would ask you to sign

Consumer protection. Managed care plans must be filed with each state insurance department and must be approved by those departments before they can be offered. As a consequence, as a consumer, you at least have some assurance that a managed care plan has been examined by the state and has conformed to state rules.

Health care reform. Under the Patient Protection and Affordable Care Act, insurance companies are required to spend 80 to 85 percent of premium dollars on medical care and health care quality improvement rather than administrative costs. If they don't, the insurance companies are required to provide a rebate to their customers beginning in 2012. The intent of this provision is to make the insurance marketplace more transparent and make it easier for consumers to purchase plans that provide better value for their money. Detailed information on the requirements of the "medical loss ratio" provision is available on the government health care website.