Do you understand what the Pooled portion of your Employee Benefit Program is?
The pooled portion of your Extended Health Benefit (EHB) is normally around $10,000 and it is your risk, similar to a deductible. The first $10,000 an employee and/or their family spend will affect your rates next year. After an employee and/or family has spent $10,000, the risk then transfers to the Insurance Company. Except for Out of Country claims, they are the Insurance Company’s risk from the first dollar. There is a separate rate for the Pooled portion of your benefit plan, this rate is usually rolled into the EHB rate unless you are a large group and they will show you this rate separately.
Every Insurance Company is different in what they will allow to go towards the $10,000 deductible. For example, Empire Life has recently brought out a $7,500 pooled (deductible) but only prescription drugs go towards reaching the pooled maximum. This means less risk to the insurance company, because appliances such as diabetic pumps, sleep apnea machines, paramedical practitioner usage, etc will not go towards the pool (deductible). However, it will reduce the pooled rate because the risk is lower to the Insurance Company.
Some Insurance Companies will combine the usage with the whole family under one pool (deductible), other Insurance Companies make each insured person satisfy the $10,000 pool (deductible). All of these differences affect the rate and your exposure.
With the increased usage under the EHB, I think it is important to start talking about your risk.
Please contact Glendinning Insurance Company, your Resource Specialist to review your pooled benefit options.