How do groups decide on health care benefits?

Who is this for?


If you are wondering what employers take into consideration when they choose what to offer for Medicare plans, this information will be helpful.

Health insurance offered to retirees by a former employer, association or trust is called group coverage.

Here are some of the factors groups take into consideration when deciding on benefits for their members.

  • Member needs: Group plan administrators may look for data on the current health and medical needs of their members. Sometimes they try to estimate the future needs of their membership as a whole. They take those into consideration when looking at offerings from insurance providers.
  • Benefits offered: Plan administrators look at the types of benefits offered by insurance companies and try to match the needs of their members with the benefits.
  • Costs:  One factor is the prices of the services and how much the member will pay in copays and coinsurance. Often, large groups can work with insurance companies to negotiate better rates or add services for their members. Group plans also may pay part or all of your monthly premium.
  • Network of doctors and hospitals: Groups often look at the quality and efficiency of the providers' care in the plan. They make sure their members have access to a strong network of doctors and hospitals.
  • Support: Most groups, like unions and other large organizations, have a contact person within their organizations to help retirees and current members with claims and other questions about the group plan.
These are just some of the factors that groups look at when deciding on benefits for their members.
If you have any questions about your specific plan, call your company's benefit office or the administrator of your plan.