Choosing the right health insurance benefit for your business is extremely crucial. To help you find the benefit that best suits your needs, we’ve listed 3 main types of health insurance plans below:
Preferred Provider Organization (PPO)
A PPO plan is a group health insurance plan, where employees are encouraged to use a network of preferred hospitals and doctors. These providers offer services to plan members at a discounted or negotiated rate. While employees don’t need to designate a primary care physician, they will have the choice to see any specialists or doctors within the network of the plan.
Employees have an annual deductible that they will need to meet before the insurance company starts covering their bills. For certain services, they may also have a copayment or co-insurance, where they would need to pay a certain percentage of the total charges of their medical bills.
Health Maintenance Organization (HMO) Plans
An HMO plan is a group health insurance policy, where employees have a lower out-of-pocket expense, but also have less flexibility in terms of choosing hospitals or physicians than other plans.
In an HMO, employees might need to choose a PCP (primary care physician). They may need to obtain a referral from their PCP if they want to consult a specialist. When it comes to preventive services, HMOs usually provide coverage for a broader range than other policies. Employees will usually have a copayment, and may or may not need to pay a deductible before their coverage starts.
Generally, on an HMO, there are no claim forms to file. However, with most HMO plans, if employees go out of their network, they will not have coverage without proper authorization from their PCP or in cases of emergency situations.
Point of Service (POS) Plans
This is a group health insurance policy that combines the features of a PPO and an HMO plan.
In a POS plan, employees may need to choose a PCP from the network providers of the plan, just like an HMO. Usually, the services rendered by the PCP are not subject to the deductible of the policy. Employees may receive a higher coverage level if they utilize covered services that are referred to or rendered by their PCP. however, if they choose services by a provider that isn’t covered by the network, they may be subject to a lower level of coverage and a deductible.