Solutions to meet your Medical Insurance needs
More than half of U.S. workers are worried their health care costs will increase and the scope of their benefits will decrease over the next few years. Watson Wyatt WorkUSA 2006 Study. (Hewitt)
Health Maintenance Organization (HMO)
Commonly, an HMO allows participants to choose a primary care physician (PCP) that is part of the contracted provider network. The participant pays only a physician co-payment and/or a hospital co-payment at the time of service, and is usually responsible for submitting claims. Participants need pre-authorization for specialty care outside of their PCP or medical group.
Point of Service Plan (POS)
A POS plan covers medical expenses whether the participant visits a participating provider or an out-of-network doctor or hospital. The participant can keep out-of-pocket expense to a minimum by seeing a participating primary care physician for routine care, and when he or she coordinates necessary specialty or hospital care.
Participants have the freedom to go directly to a primary care physician, specialist or hospital for medically necessary care at any time and are responsible for the deductible and coinsurance outlined by the plan.
Preferred Provider Organization (PPO)
A PPO gives participants the option of receiving medical care from participating providers or nonparticipating providers. Care received from a participating provider generally has a corresponding copayment. For services other than nonprocedural office visits, the participants may pay a deductible or coinsurance or both, depending on the type of service or facility. When receiving care from a nonparticipating provider, the appropriate coinsurance and deductible amount will apply.
Exclusive Provider Organization (EPO)
EPO's are similar to PPOs in their organization and purpose. Unlike PPOs, however, EPOs limit plan participants to using only participating providers for their health care services.
Indemnity Plan
Indemnity Health Insurance can be purchased to cover comprehensive major medical benefits. Plans may be offered on an individual or group basis. Participants may go to their physician of choice to access care. A deductible must be met before any coverage applies and the participant pays a coinsurance (of usual, customary and reasonable charges) for covered services. Participants submit their own claims.
Self-Funded
Plan sponsors who want greater control of their plan, and who are willing to manager more of the plan finances may want to consider self-funding. Plan design can be tailored to meet a group’s needs and multiple funding options are available which can help control expenditures.
