As an employer, choosing the right health care plan for your employees involves evaluating the associated costs and the level of coverage offered. These decisions should also be considerate of what types of medical specialists are included. Before you decide what types of specialists you want to include, you should be aware that there are specific services that you must include in your plan.
The Essential Services
The Affordable Care Act outlines 10 specific services that must be covered within any type of health care coverage offered to your employees. These services and medical specialists include the following:
- Ambulatory patient services.
- Emergency services.
- Maternity and newborn care.
- Mental health services, substance use disorder services and behavioral health treatment.
- Prescription drugs.
- Rehabilitative and habilitative services and devices.
- Laboratory services.
- Preventive and wellness services and chronic disease management.
- Pediatric services, including oral and vision care.
Depending on your industry and situation, you may decide to select additional specialists who can address the specific needs of your employees. Taking into account the occupational hazards faced by your employees, providing services from medical specialists not currently included in your health plan may be in the best interest of your company.
According to a report by the U.S. Bureau of Labor Statistics, certain occupations, including nursing and laborers and freight movers, experience high levels of musculoskeletal disorders related to their jobs. In the event that you employ individuals within this job category, you may want to consider adding chiropractic services, occupational therapists or orthopedists to your existing plan. Other occupational areas with a high rate of injury include agriculture, manufacturing and construction.
When making the decision to choose a plan with additional specialists, you may also want to consider whether expanding the network would keep the plan affordable for your employees. Per the Affordable Care Act, if an employee’s share of the premium is more than 9.5 percent of his or her annual household income, the coverage is deemed unaffordable. Should it be determined that your coverage is unaffordable, you could face an Employer Shared Responsibility payment. If you determine that your employees will not be able to afford an expanded plan, consider setting up a health savings account that employees can use to pay for visits to specialist providers.
Researching the most common workplace injuries that impact employees in your specific sector can assist you in choosing additional medical specialists to add to your current health plan. When you’re choosing a medical plan for your employees, consider the costs for both your business and employees. In order to choose the best plan for your employees, discuss the above options with your broker.
Allison Hutton is an experienced writer, editor, communications professional, researcher and social media consultant. During her more than 15 years of communications and writing experience, Allison has worked with a variety of clients, from small-business owners to Fortune 500 companies. She has an M.S. in entertainment business, a B.A. in communication and lives in Pittsburgh, Pennsylvania, with her husband and four children.