Here is a life lesson, drawn from the well of experience, we would all be wise to take in and remember:

 

 

If we were to reflect upon the outcomes of our decisions over the years, we would likely find that this lesson applies to decisions both large and small, in both personal and business life. 

 

As professional benefit management advisors, we routinely help our clients understand the true costs of the decisions they are making, especially when it comes to the healthcare benefit options they provide their employees. We are responsible to put our clients’ best interests first by investigating, expertly thinking it through and then educating them on the “pros” & “cons” of their particular benefit management options—and the costs involved with making those decisions.

 

Consider a common “money-saving” strategy pitched to employers by group insurance salespeople in order to try and win a prospect’s business—The Prescription Carve Out. You’ll find another article dealing with a second “pitch” here. Sadly, we have found that these Sales Pitch Pro’s rarely discuss the full potential cost of strategic decisions such as these. Here’s how it is typically presented:

 

 

A little knowledge of the market will help illuminate one of the big “cons” with this pitch. Stop loss high claim protection insurance on a carved-out prescription plan is difficult to find at best, and impossible to find in most markets. That means the employer in this self-funded position would be responsible for all prescription claims – as they are incurred – with no financial protection.

 

After researching, you will find there are drugs that can cost $10K, $20K or even $30K or more PER MONTH!   Unfortunately, especially with the high cost of many of the new bio-med drugs, it takes only one health plan member with a high-cost condition (MS, Hemophilia, etc.) to quickly exhaust, and then surpass, the savings this strategy initially offers.

 

Some of these strategies may initially appear to have merit, but after carefully examining the pros & cons, most of them actually expose the employer to more cost and financial risk or force them to make future health plan management decisions they were not prepared for. We encourage our clients, and all employers, to fully examine the pros & cons of their health plan management options before making decisions, because every decision costs something—and self-funding prescription drugs is no exception.