What are essential health benefits

These are the essential health benefits for employees:

  • doctors’ services
  • inpatient and outpatient hospital care
  • prescription drug coverage
  • pregnancy and childbirth
  • mental health services

Let us discuss these in detail below:

Doctors’ Services

It covers the services rendered by either a physician or a dentist while in hospital or not. This also includes the services of an osteopath, chiropractor, podiatrist, and optometrist.

It also covers the services of a nurse practitioner or clinical nurse specialist, physician assistant, and other non-physician providers. (See the list of non-physician providers here .)

Inpatient and Outpatient Hospital Care

It covers hospitalization which may include:

  • inpatient care in a hospital 
  • or in a hospital-based facility like a residential rehabilitation facility
  • outpatient care in hospitals or hospital-based facilities

It also covers payments made to providers of services under Medicare Advantage. Prescription Drug Coverage It includes most prescription drugs like antibiotics, antidepressants, antidiabetics, etc. It also includes insulin and other medically necessary prescription drugs that are not covered by Medicare Part D.

Pregnancy and Childbirth 

It includes maternity (pregnancy) and newborn care for both the mother and child for an average period of about one year. This includes prenatal care, childbirth delivery, and postnatal care for infant care for about one year after delivery. It also includes breastfeeding equipment and counseling for about one year after delivery. 

Mental Health Services 

It includes outpatient mental health treatment to treat mental illness, alcohol abuse, or drug abuse problems. These services can be provided to adults as well as children below 18 years of age. 

Why Do Employees Need Health Insurance?

Employees need health insurance for several reasons:

  • It is a legal requirement in most states. 
  • It is cheaper than paying for health care expenses out of pocket. 
  • In addition, it protects employees and their family members. 
  • It also provides financial relief in case of unforeseen medical emergencies. 
  • It allows access to a range of health facilities. 
  • And lastly, it gives peace of mind to employees.

What are the Benefits of a Health Insurance Plan for Employees?

If you are an employer, you may wonder what the benefits of a health insurance plan are. Here are a few:

  • It is always better to have one than not to have one.
  • Employees can get the health care treatment they need for themselves and their family members.
  • Employees feel motivated to work hard for the benefit of their families.

There is a clear financial benefit for employers which is easier cash flow management, lower health care costs, reduced employee absenteeism, and higher productivity as a result of employee well-being.

Employees can also buy additional health care products like dental or vision coverage. 

How Do Employers Select a Health Insurance Plan?

There are several ways that employers select a health insurance plan:

  • They can ask employees to choose from several plans 
  • They can negotiate with insurance providers 
  • Or they can ask employees to make recommendations They can consult with an insurance broker 
  • They can go online and select a plan themselves 
  • They can decide on a plan after comparing the cost of different plans against their budget 
  • Also, they can take the advice of an expert in this field or even the advice of their accountant. 
  • They may even select more than one plan depending upon their budget and requirements. 

Employees will be able to choose from a range of options as well. 

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