When applying for a job, most people are interested in the pay rates and the health insurance. Group health insurance plans through employment are typically the most affordable options for the average person in the United States. As an employer, it is important to understand the different types and options that are available. There are plans that are made for small businesses and large businesses.
What are the Different Types?
There are two different types of plans available. These are the most commonly used through employment. These plans are PPO and HMO. HMO is used far more than PPO, but both have become what most businesses rely on--large or small. For both of these plans, there is an option to not only supply the employee with health insurance. They also provide the option to have their family covered. This does mean the employee pays out more, but it is far more affordable than using private insurance.
What are HMO Plans?
HMO stands for Health Maintenance Organization. There isn't a ton of freedom when it comes to using the doctors you may want to use, unless you get lucky. There are restrictions that one must pay attention to. For example, there are lists of doctors and medical facility locations that people under these plans can go to. While there are many people that find great doctors on these lists, this can bring about issues for those that already have medical histories with doctors they trust. They will have to "shop around" to find a doctor that is on par with the one they have already trusted for years.
HMO Plans & Point of Service Options
For those that would like to still have an HMO through group health insurance plans while using whatever doctor or hospital they would like, they may be able to pay more for the freedom to do so. While most opt to simply save money and find a new doctor, there are those that opt for the "Point of Service" option. Restrictions vary, but for the most part they are able to see the medical professionals that they prefer.
It is mandatory that those covered by an HMO select a primary care physician. This is the person that they go to for most health issues and are referred to specialists through them.
What Do HMO Plans Cover?
These plans cover medications, health care through a set list of providers, emergency services coverage, and certain annual screenings. Despite having to choose from a network of providers, those under the plan typically have access to many more preventative services than other options.
PPO Group Health Insurance Plans
PPO is not much different from HMO. PPO stands for Preferred Provider Organization. There are perks to this plan, however. The customer using this type of plan will end up paying less for deciding to use doctors and specialists under the PPO's preferred network. The premiums are higher by a little, but the co-pays and medications tend to be more affordable.
Can I See a Doctor Outside of the Network?
This is where another difference comes into play. You and your employees will be able to see doctors outside of the network, it simply costs more to do so. This option is why PPO plans are becoming more popular these days. People want the freedom to see who they want and if that means paying more, they may not mind it. They feel less restricted in this type of policy.
A Note on Drug Coverage with PPO's
For those that need drug coverage, they may need to sign up for a plan that specifically states that they offer it. There are some plans that do not have this option. If you are an employer, it is important to pick the plan that is best for your employees. Without prescription coverage, they will end up shelling out a lot of money to make sure they get their medications. It is always recommended to go over the coverage that all plan options have before deciding on one.
Specialists and Primary Care Doctors
While it may be more convenient to have a primary care doctor either way, it is not mandatory under PPO insurance. You also do not need referrals to see specialists, which can save you time and money if you know what you are doing. With HMO's, someone has to go to their primary care doctor first and then get a referral to the specialist. The primary care physician ends up essentially being a middle man that costs the patient even more money. That is not the case with PPO coverage.
When it comes down to it, picking a group health insurance plan is up to the employer. For those that want to keep costs down and make sure their employees remain healthy, making an informed decision would be your best bet.