Employee Health Benefit Plans Solutions
There are four fully-funded Medical Plans available:
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PPO - Preferred Provider Organization
You are allowed to self-refer to any provider in the netwrok. When using the in-network providers, the higher level benefit is recieved. This may be as much as 90% after the deductible. The benefit level for providers out of the network is typically 70% to 80%. Pre-authorization requiremetns must be met in or out of network. Providers in and out of network usually have a Doctor Office Copay -
POS - Point of Service
Very similar to an HMO in-network plan. It uses a "gatekeeper" (Primary Care Physician or PCP) to refer cases to other in-network providers. Deductibles usually only apply to out-of-network care. Co-insurance is either 90% or 100% for in network providers. Services recieved out-of-network are typically paided at the 60% to 70% level. There are exceptions...typical an emergency while away from network providers or treatment required from specialists not available in-network -
HMO - Health Maintenance Organization
The HMO uses a Primary Care Physician to direct all health care. No benefits are available outside of the provider network except when there is an emergency. HMO plans focus on wellness and preventive medicine and is the highest level of managed care. -
Indemnity Traditional coverage
The insured individual is free to use the doctor, clinic, or hospital of their choice. Both a deductible and a co-insurance apply and there are normally no co-pays for doctor office visits.
