ITUP just switched to SHOP coverage through Covered California. In December 2013, we began to assess whether SHOP would be a good fit for our employees. The SHOP gold tier of coverage was about the same coverage as we already had, and it would cost us less per capita.
We next asked whether our staff wanted a choice of plans and providers; their answer was a strong “yes”. In fact that “yes” was so strong that some indicated they might drop their “other” coverage – a savings for them, a cost for ITUP.
We needed to assess whether and in which plans, our staff’s preferred physicians participated. This was not an easy task, as it requires the employee to check out the provider directory of each of the plans offered through SHOP. In some cases their personal physicians were not sure they wanted to participate in SHOP plans, whether their IPA was participating, and in which SHOP plans they were participating. So this requires some research on the plan’s web sites.
SHOP gives a choice of PPOs and HMOs and the prices vary by plan. At ITUP, we decided to tie the ITUP contribution to the mid-priced plan. Employees choosing the more expensive plan would pay the extra cost and employees choosing the less expensive plan receive the incremental savings.
It takes a bit of time and paperwork, some patience and persistence, but the net for ITUP was a savings in per capita costs and staff more satisfied with their health coverage. This is the first in a series of ITUP’s experience SHOP-ping.
For more information on the SHOP, see Covered California’s website. Small business with up to 50 full time employees can participate. At this time, enrollment is by paper application, through licensed brokers, or through the SHOP hotline.