Health Plan Design Trends for 2013

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January 11th, 2013

Health Plan DesignAs the healthcare landscape transitions, self-funded employers and insurers are reassessing their health plan designs to better cope with costs and impending changes.

An estimated 2,000 large employers plan to migrate from more traditional plans to health plan designs that will prepare them for Affordable Care Act requirements and attempt to keep their premium contributions stable. Typically, trends driven by large corporations have an effect on small companies by influencing self-funded plan decisions and insurer policy offerings.

Below we review 5 health plan design trends employers are considering in the year going forward.

1. Narrow Provider Networks

Narrowing provider networks in exchange for lower premiums is becoming one of the most notable trends amongst employers. The idea of receiving generous price breaks for access to a more limited network is attractive to employers and also to their employees if some of those savings are passed onto them.  Narrowing provider networks best suited for small to midsize businesses with the majority of their employees concentrated in a specific geographic location. Employers exploring this option should consider the value of health systems and providers in order to choose which should be included in these limited networks. Large companies with employees in a variety of areas will most likely not benefit from a limited area of providers.

2. Increasing Copays, Deductibles or Employee Responsibility for Premium Amounts

Shifting more of the costs onto employees through raising copayments and deductibles is another trend employers are considering in order to reduce premium amounts.  Plans that maintain broad networks could possibly see copayments as high as $50 per office visit. Some employers are tying higher deductibles, copays and premium contributions to broader network access while offering less out of pocket expenses as an incentive if they choose to join a narrower provider network.

3. Implementing Tiered Employee Contributions by Salary

Varying employee contribution amounts according to salary is another way to control costs. Tiered contributions percentages based on salary brackets would require employees earning more to make a larger contribution towards their health plan than employees who are paid less.

4. Vary Health Plan Options based on Wellness Participation

Another trend is to offer a ‘superior’ plan with the highest employer contribution to employees who participate in wellness and preventative programs. Other employees unwilling to participate in these programs would be only eligible for plans with a lower employer contribution.

5. Consumer Driven Designs

Consumer driven plan designs expose employees to the direct costs of care up to a predetermined limit. This plan type can encourage consumers to make more conscious decisions on their consumption of healthcare, from how often it is used to the choice of setting. Health Savings Accounts (HSA) and high-deductible plans are both examples of consumer driven designs. These plan options have become increasingly common in plan designs with 58% of employers offering consumer driven health plans (CDHP) in 2012.


PayerFusion offers a variety of health plan administration and cost containment services to insurers, third-party administrators and self-funded employers. Our services include provider network design/support, policy design, full-service TPA, technology solutions/support and informatics as well as access to our PayFuseNet provider network.  Contact us for more information on how PayerFusion can help design and manage your health benefit plan.

One Comment

  • Kenneth Hunt says:

    This is the logical progression together with the integrated and efficient payment mechanisms that simply the payment process and mitigate the need for costly and complexed claims adjudication processes.