plans, which they can customize to employer needs and the requirements of specific markets (e.g., state mandates for inclusion of specific benefits). The benefit package has to meet what the employer considers an affordable premium for the company and the employees. The overall premium will reflect which services are included, included but with limits, or excluded; deductible and co-payment levels or co-insurance requirements; the network of providers; the insured group’s risk profile; the degree of medical management in the policy; and health plan administrative expenses, overhead, and profits. A plan with more excluded services, a narrower network of providers, more restrictive visit limits, and higher employee deductible and cost sharing will tend to have a less expensive premium for a comparable set of covered benefits.



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