Employer Sponsored Medical Insurance
We research the markets and are able to present you with several options. Your choices range from consumer-directed approaches to preferred provider organizations. Coverage levels also vary from comprehensive preventative benefits to chronic care.
With a PPO plan, employees are encouraged to use a network of preferred doctors and hospitals. These providers are contracted to provide service to plan members at a negotiated or discounted rate. Employees aren't required to designate a primary care physician but will have the choice to see any doctors or specialists within the plan's network.
Employees have an annual deductible they'll be required to meet before the insurance company begins covering their medical bills. They may also have a copayment for certain services or a co-insurance where they're responsible for a percentage of the total charges of their medical expenses.
With a PPO, services rendered outside of the network may result in a higher out-of-pocket cost.
Preferred Provider Organization
With an HMO plan, employees generally have a lower out-of-pocket expense but also have less flexibility in the choice of physicians or hospitals than other plans. An HMO requires employees to choose a primary care physician (PCP). To see a specialist, employees will need to obtain a referral from their PCP.
HMOs generally provide coverage for a broader range of preventative services than other policies. Employees may or may not be required to pay a deductible before their coverage starts, and will usually have a copayment.
Most of the time, there are no claim forms to file on an HMO. The main thing you will want to keep in mind is that with most HMO plans, employees have no coverage if they go outside of their network without proper authorizations from their PCP or in cases of certain emergency situations.
Health Maintenance Organization
POS plans combine features of an HMO and a PPO plan. Just like an HMO, POS plans may require employees to choose a Primary Care Physician (PCP) from the plan's network providers. Generally, services rendered by the PCP aren't subject to the policy's deductible.
If employees utilize covered services that are rendered or referred by their PCP, they may receive a higher level of coverage. If they utilize services by a non-network provider, they may be subject to a deductible and lower level of coverage. They may also have to pay up-front and submit a claim for reimbursement.
Point of Service
Indemnity health plans are known as fee-for-service plans because of pre-determined amounts or percentages of costs paid to the member for covered services. The member may be responsible for deductibles and co-insurance amounts.
In most cases, the member will pay first out of pocket and then file a claim to be reimbursed for the covered amount.
EPO plans are similar to HMO plans because they have a network of physicians their members are required to use except in the case of emergency. Employee members will have a Primary Care Physician (PCP) who will provide referrals to in-network specialists. EPO members are responsible for small co-payments and may require a deductible.
Exclusive Provider Organization
An HSA is a tax-favored savings account that is used in conjunction with an HSA-compatible high deductible health plan to pay for qualifying medical expenses. Though HSAs can be attached to group health insurance, they're owned by employees and small businesses can contribute to them whether they offer a group policy or not.
The contributions to an HSA may be made pre-tax, up to certain limits set by the IRS. Unused funds in an HSA account roll over each year and accrue interest, tax-free. Funds may be used for other life events as well but may incur penalties and interest to be paid.