If you are an employer who offers health care coverage to employees, you face all kinds of questions and concerns about plan benefits and costs. In addition to running a business, making appropriate decisions about your employee health plan requires you to be a benefits manager, communications specialist, and financial analyst. It is difficult enough to fill these roles when employees have routine health problems, but when an employee is affected by cancer, heart disease, a sick or premature baby, or HIV, you may face some difficult issues. Treating HIV and AIDS is expensive. However, don't check compassion, reason, and common sense at the door when trying to respond to AIDS. Treatment and management for HIV or AIDS is no more expensive than treatment of several other conditions, including breast cancer, severe head injury treatment and rehabilitation, or the care of a premature, low-birth-weight baby.
This information is intended to help employers who are concerned about the impact of HIV/AIDS and other expensive illnesses on their health care costs and their businesses, especially employers with fewer than 100 employees. This information can be useful to any employer who wants to maintain health insurance for employees in the face of rising costs or who self-insures. HIV/AIDS is only one of many issues you should consider when deciding how to design and manage your health plan.
In reviewing your health plan, there are a number of issues to consider, including coverage of preventive and diagnostic services, catastrophic coverages, and co-payment/ deductibles. Here are some features of health plans you may consider to keep your costs under control:
Many businesses are looking at preventive care coverage. Also learn which screening and medical tests, including HIV/AIDS counseling and testing, are cost-beneficial and incorporate them into your plan. Until there is a cure for HIV/AIDS, education and prevention are the key.
Your employees' routine health care can provide some of your best opportunities to save on the costs of coverage. A plan that offers low or no deductibles and low or no co-payments by participants, is paying many small and relatively predictable health care bills. Raising deductibles and employee co-payments could reduce your plan cost significantly.
Spend some of your savings from increased deductibles and co-payments on better protection against catastrophic health care expenses. Make sure your plan's annual limits on participants' out-of-pocket expenses, as well as annual and/or lifetime limits on benefits, reflect both inflation and the growing cost of modern medical technology. Make sure you learn your plan's cap on prescription drug coverage. Some insurance plans have relatively low caps for prescription drugs and do not provide ample coverage for drug therapies. These drug therapies can increase quality of life and add to the overall productivity of employees. Your employees may be more willing to accept lower coverage for small, routine expenses if they know they will be protected when they need it most.
Many small employers report that managed care plans help them maintain affordable coverage. Such plans limit employees' ability to choose their physicians or hospitals but may offer significant benefits in return. Employers are becoming increasingly interested in prevention programs to keep their employees healthy and productive. Employers get significant price discounts as well as other services aimed at delivering cost-effective health care that meets or exceeds acceptable standards of medical care. Employees, in turn, get plans that are simpler to use, with little or no paperwork or cost sharing, and physicians who coordinate all aspects of their health care.
People living with AIDS, as well as those with any other serious illness, may in some cases be better off with home care or in a hospice, nursing home, or other facility than they would be in a hospital. Make sure your plan provides adequate coverage for such care.
You may be able to buy health care coverage through a multiple-employer trust in which several small employers join together to obtain the buying power available to larger groups. Such trusts may be offered through your trade association or professional association, your local Chamber of Commerce, or other groups. Before joining, however, have your accountant or attorney check out the financial soundness of the trust and how it is regulated.
It is important to understand what, if any, experimental treatments, including experimental use of approved drugs, are covered by your plan. This is an area where there can be costly misunderstandings—costly in dollars as well as employee relations. "Experimental" can mean one thing to a layman and another thing to the doctor and insurance company or managed care plan. It can also have different meanings among insurance and managed care companies. Although it has been, and in many cases continues to be, standard procedure for private and public health plans to exclude all experimental treatments from coverage, this is changing. Because AIDS relies on experimental drug treatments and therapies, such as protease inhibitors and other antiretroviral drugs, there are clinical trials that determine the effectiveness of their efforts.
These are some of the people and groups that can provide information on questions you may have:
