When it comes to selecting benefits, the options can be overwhelming. There is a lot to consider, including network, service and plan design. A benefits network includes all the in-network options of doctors. For vision, the network may include optometrists, ophthalmologists, retail locations and optical shops. Some may also include Lasik and telemedicine practitioners. When evaluating a benefits network, it may be helpful to examine the proximity of providers to members, the number of access points available and quality measures taken by the benefits partner when adding network access points.
Most employees are interested in convenience. Whether they are looking for someone close home or work, ensuring employees have access to care is important. Some people value the flexible weekend and evening hours of retail, while others prefer a smaller location with more personalized service. Be sure to examine the overall range of the network, as well, so employees and their dependents have options wherever they go.
Many networks are described as having a large number of providers. It is important to consider if the network is looking at access points or unique providers. An access point is a general count of number of providers per location. For example, if Dr. A works at 3 locations, he would be counted three times. In contrast, a unique provider count would include Dr. A only one time. Before selecting a benefits plan, be sure that the network has an adequate selection of both unique providers, in addition to access points, so that members can select from a number of unique providers and also from convenience.
Both you and your employees are looking for quality providers. Unfortunately, it is impossible for you to research every provider in-network with each benefits partner. Instead, some plans handle the research for you through a process called credentialing. The National Committee for Quality Assurance (NCQA) defines credentialing as “a process by which an organization reviews and evaluates qualifications of licensed independent practitioners to provide services to its members.” Prior to panel membership, plans following NCAQ review license, sanctions, education, work history and more to ensure all providers meet requirements set forth by NCQA.
If you keep these suggestions in mind, navigating the world of benefit networks might make selecting the best benefits partner easier.