Given the choice this past fall, about one quarter of nearly 5,000 employees at St. Paul Public Schools opted for a new "narrow network" health plan in 2019.
Called SmartCare, the new option from insurer HealthPartners limits access to in-network primary care at just three clinics, including two clinic spaces that opened this month. Workers can see premium discounts of nearly $200 per month for family coverage, but they pay more money out-of-pocket if they want to visit an out-of-network doctor or hospital.
Narrow networks aren't a new strategy, benefit consultants say, but they're coming in new packages. So, workers could be hearing more about narrow network plans as employers keep searching for ways to control the never-ending rise in health care costs.
The consulting firm Mercer published survey results last year showing that 5 percent of employers with more than 500 employees, and 14 percent of firms with more than 20,000 workers, offered a narrow network health plan. There's no set definition for what constitutes a narrow network, but Mercer described it as a "subset of the broad provider network selected for quality / cost-efficiency."
"Our results have indicated that while many health plans now offer [accountable care organization plans] and narrow networks to maximize the benefit of high-performance provider networks, employers have to be willing to steer more employees to use them," said Rey Balcazar, Mercer's leader for health practice, in an email.
How much more do employees pay for out-of-network care?
It varies by health plan, but at St. Paul Public Schools the out-of-pocket cost requirements by way of deductibles and co-insurance are capped at anywhere from $1,000 to $6,000 per person per year, and $3,000 to $11,500 per family per year.
One of the big questions with the health plans: What's the quality impact when patients face financial barriers to see certain doctors and hospitals?
