How to Understand Your Employer-Sponsored Health Insurance

A Classic Infographic for Lemonly

#healthcare #Insurance

Navigating insurance is an important part of healthcare in the United States. Many people choose to enroll in health insurance through their employer, but the system is often difficult to understand.

That’s why we created this infographic to help folks visualize the costs and benefits of their employer-sponsored health insurance. We’ll walk you through why employers choose to offer health insurance coverage as a benefit, how the employee and employer contribute to the cost of insurance, and some of the major differences between the two most common health plans.

Interested in using this as a resource for yourself or your team? Click below to download a printable PDF version to use and share with your employees.

Download a printable PDF »

How to Understand Your Employer-Sponsored Health Insurance Home of the world's best infographics How to understand your employer-sponsored health insurance Navigating health insurance isn’t always easy, but taking the time to understand your coverage can help you take care of your health and your wallet. What is employer-sponsored health insurance? Employer-sponsored health insurance is a benefitthat makes healthcare coverage more affordable.Employers may partially or fully cover the cost ofinsurance premiums, allowing employees to receive medical care at a reduced rate. Why do employers offer health insurance? Attract and keeptalent Offering health benefitsmakes a company moreattractive to prospectiveemployees and boostsemployee retention. Promote employee well-being Providing health insurance demonstrates a commitmentto the health, happiness, andmaterial well-being ofemployees. Maintaincompliance Employers of a certain size must offer health insuranceto full-time employees toavoid penalties. Do employers have to offer health insurance? Technically, no. But employers with 50+ full-time employees must provide health insurance to at least 95% of their full-time workforce or pay a hefty fine to the IRS. The 5 costs that make up a healthinsurance plan You pay Insurance Deductible reached 1. PremiumThe amount you and your employer pay each month for health insurance. When you pay: Each month, often as an automaticpayroll deduction. 2. CopaysThe discounted price you’ll pay for medications and visits to the doctor. When you pay: At the time of service. 3. DeductibleThe amount you pay before health insurance starts covering your bills. When you pay: Whenever you pay costs outside of your copays and premiums. 4. Co-insuranceThe percentage of medical costs you pay after meeting your deductible. When you pay: After you've reached your deductibleand require any other services. 5. Out-of-pocket maximumThe maximum amount you pay for healthcare each year. Your deductible, copays, and coinsurance all contribute to your out-of-pocket maximum. Choosing a health insurance plan You’ll likely have at least two options for employer-sponsored health insurance:a traditional plan and a high-deductible health plan (HDHP). Traditional Plan HDHP Premium Copays Pay a lower fixed ratefor appointments Pay more for appointments (insurance discount applies) Deductible Co-insurance No costs after meeting yourdeductible Out-of-pocket maximum Your deductible is your out-of-pocket maximum Risk level Low High Flexibility Low High HSA-eligible* Can add spouse/family members *HSA (Health Savings Account): A tax-advantaged account used to pay medical expenses.Yours to keep even if you change plans or employers. What’s covered in your healthinsurance plan? In-network providersInsurance plans have preferred networks of providers. Staying in-network can significantly reduce your healthcare costs. Prescription drugsCheck your plan's prescription drug tiers (generic, brand-name, specialty drugs) and prior authorization requirements. Essential Health Benefits (EHBs)According to the Affordable Care Act, insurance plans must cover: Outpatient services Emergency services Hospitalization Maternity and newborn care Mental health/substance disorder services Prescription drugs Rehabilitative/habilitative services and devices Laboratory services Preventive services/chronic disease management Pediatric oral and vision care Your health is irreplaceable, and being informed about insurance is vital to your well-being. Contact your human resources department to learn more about your specific coverage details.