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Get health insurance at work? 4 things to know during open enrollment



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Like lots of companies, Southern California Public Radio is in the midst of open enrollment season. My colleagues were not thrilled to learn recently that our health insurance premiums are increasing 11.5 percent in 2016.

I turned my co-workers' frustration into a mission for Impatient: Find out why our premiums are rising, and how this increase compares with what's going on at other companies.

Is your premium changing?

Here's what I learned about our premiums: Our company has a self-funded insurance plan, meaning it pays for every claim that's submitted. Claims submitted during 2015 were higher than expected, according to SCPR's HR department.

The company was left with a decision: It could increase premiums, deductibles or other out-of-pocket costs, or change its plan designs. For next year, it chose to increase premiums across the board.

Rising premiums are not uncommon. Between 2014 and 2015, the average annual premiums for employer-sponsored health plans nationwide increased 4 percent, according to the Kaiser Family Foundation's annual employer health benefits report. That was considered a moderate increase; instead of increasing premiums in recent years, many employers shifted costs to their employees through increased deductibles, explains Karen Pollitz, a senior fellow at Kaiser.

The foundation does not yet have data on 2016 plans for employers of all sizes. But among very large businesses of 1,000 employees or more, premiums are expected to increase an average of 5 percent in 2016, according to Brian Marcotte, president and CEO of the National Business Group on Health.

SCPR's insurance plan is through its parent company, American Public Media, which has about 650 benefit-eligible employees. The company's 11.5 percent increase for 2016 is high compared with last year's trends, says Pollitz.  

Specialty drugs – like those that treat Hepatitis C – are also becoming a larger driver of increasing health costs, Marcotte says. His group, a nonprofit that advocates for large businesses on health policy issues, surveyed 140 large corporations this summer and found that employers are expecting to pay 22 percent more for specialty drugs in 2016.

If you have employer-sponsored health insurance, here are three more things you should be aware of:

Is your deductible changing?

As I mentioned above, one way that employers have prevented a larger increase in premiums is by shifting some cost responsibility to employees, in the form of high-deductible health plans.

Almost one-quarter of employees now have high deductibles, up from 13 percent in 2010, according to the Kaiser Family Foundation.

As employees become responsible for a larger share of their health care costs, employers are offering more tools to help people become smarter health care consumers, Marcotte says.

For example, he says, three-fourths of large companies are offering transparency tools that are intended to help employees make decisions about their care, based on both price and quality.

Is your employer offering tools to make health care more convenient?

Nearly three-quarters of large businesses are offering telehealth in 2016, Marcotte says. These sorts of virtual visits can be more efficient – from both a time and cost perspective – than visiting an emergency room or urgent care center. This is especially true when it comes to after-hours visits, he says.

More employers are also offering personalized services to help people navigate the health care and insurance system, Marcotte says.

He acknowledges that businesses are rolling out these new initiatives in part to hold down their health care costs. But Marcotte says the goal is bigger than that.

"Healthier employees are more engaged employees, and more engaged employees drive better business results and business outcomes," he says. "If I have a healthy, engaged employee, they're going to be more productive both here and in their life A more productive employee will lead to better business outcomes as well. It all makes sense."

Are you taking advantage of wellness programs?

Like many companies, ours offers a wellness program. I tried signing up for it when I joined the company, but things never panned out and I never followed up.

But Michael Thompson, a healthcare and employee benefits expert with PwC, says people should take a close look at their companies' wellness plans.

Under some plans, he says, wellness is incentivized with gift cards or additions to people's paychecks. Sometimes participation in these programs leads to lower premiums, and "you don't want to miss the opportunity to hold those premiums down if that's given to you," he says.

I took Thompson's advice, and discovered that by not enrolling in our plan, I've been leaving money on the table.

Here's what I learned about SCPR's wellness program: When you sign up, you get an activity tracker. If you reach certain goals, you can earn gift certificates. If you reach loftier goals for four quarters in a row, the company will contribute $200 toward your deductible for the next year.

What questions do you have about health insurance during open enrollment season? Leave your questions in the comments section below or e-mail them to Impatient@scpr.org. We'll get through this together!