Rx medical reimbursement - single, couples,etc

Paul in Cannon Beach

We are looking at changing our medical insurance to a plan that has no prescription coverage. The big benefit is the premium savings which is significant because the organization pays 100% of the employee and dependent's premium.

If we lose prescription coverage, we are considering different options. One option would be setting up some type of annual reimbursement arrangement: $500 for single EE's, $750 for couples, and $1000 to families. So, EE's could bring in their RX reciepts for reimbursement up to whatever their annual limit happens to be based on family size.

Does anyone see a problem with offering different amounts to different EE's based on marital status, children, etc?

I have looked into this myself and have gotten mixed responses. So I am asking for more feedback. Thanks!

System

Hi Paul!

I don't see a problem with it, just as different deductible amounts are offered to different tiers. I think those reimbursement amounts are a little low, however. Some maintenance meds for a single person may cost way over $500. But I guess it all has to be weighed against the employee's savings in premiums.

I know you did the math. Is the premium savings greater than the maximum amounts you would reimburse under this new option?

POPEYE

Paul, I think you need to do a little more "shopping" for insurance. While I do understand that the RX factor is major in pricing, your reimbursement plan I feel would lead to some very disgruntled EEs. Some maintenance drugs can be as much as $200-300 dollars a month and I'm sure you will have multiple EEs with 1,2 or 3 prescriptions.

We just changed carriers and went with one that has a 3 tiered drug plan and also has a step-therapy program for certain drugs where they require that the generic or name brand be tried before authorizing a formulary drug. We actually were able to lower the premiums we were charging our EEs and they still have excellent coverage.

Paul in Cannon Beach

Thanks for your input.

My numbers were a bit misleading. The figures I spoke of were one of several options. The option we looked hardest at was a 70% reimbursement up to $6000 per employee anually.

Ultimately, as of 2:00 pm Pacific Time we have decided that prescription costs are such that it would be very difficult to drop them from our insurance plan.

So we are going with a plan that includes prescription coverage.

What a crazy week. Hope you all have a good weekend.

dynamite9551

Hello, Paul -

Our small medical office of 37 also recently felt the crunch of premium increases; however, the most used benefit is the Rx plan. we went to the employees and asked them for feedback. they overwhelmingly agreed to continue to pay for this benefit rather than lose it altogether. We pay 75% of all premium and the EE pays the other 25% regardless of whether they are single, double, family, etc. However, this is where my creativity will come into play by reconstructing our contribution without bankrupting either the practice or the employee. It will still be a win-win solution for us as we see it.

Good luck!