When evaluating a group health plan the rates and
benefits of the different plans should be evaluated. By
reviewing the different options you will have a better understanding of how the
benefits are structured and what factors are included.
Some of the factors include:
Type of Insurance plan (PPO, HMO, POS)
Office Visit Co-Payments
Co-insurance
Deductible
Provider Networks
Prescription Card
Emergency Room Co-pay
Maximum Out of Pocket Expense
There are basically 3 types of plans or
managed care available to consider when selecting a plan; Health
Maintenance Organization (HMO), Preferred Provider Organization (PPO) and Point
of Service (POS).
Health Maintenance Organizations (HMO)
allows you to receive a select set of benefits for usually a set fee.
Most HMO plans require a small co-payment for an office visit, usually
around $15 - $25. To utilize an HMO plan correctly you must pick a
Primary Care Physician from the list of providers. This doctor will
take care of all your health needs and should be the only doctor you utilize
unless they refer you to another physician.
Preferred Provider Organizations (PPO)
gives you the flexibility to utilize a large pool of doctors covered under
the network. A provider directory will list the doctors to choose
from. Typically, a small copayment plus a deductible must be met
before benefits are paid. After the deductible is met, the coinsurance
percentage is paid on the remaining charges incurred.
Point of Service (POS) is a combination
of an HMO and PPO plan. This type of plan is similar to an HMO plan
but gives you the flexibility to consult any doctor without a referral from
your primary care physician. If you receive benefits from a doctor
outside of the network, you will pay a higher amount than if you stayed in
network. These plans allow you to utilize any doctor in the plan or
not but will penalize you if you go out of network.
For more information on group plans please complete
and submit this form.
