Plan Descriptions
What is a HMO?
HMO (Health Maintenance Organization): These plans usually have excellent benefits at reasonable premiums. Most of an individual's health care is directed through a Primary Care Physician (PCP). Most HMO's do not require a referral to OB/GYNs, Dermatologists or Mental Health Providers. Services in a HMO are usually provided by physicians who are employed by, or under contract with, the HMO. Depending on the type of HMO, services may be provided in a central facility, or in a physician's own office. No benefits are available for out-of-network charges.
Advantages to a HMO: Typically you will receive more benefits for your premium dollars in an HMO plan than other types of plans due to how the fees for services are paid.
HMO Features:
- Routine visits are typically covered with a nominal co-payment.
- Usually there are no claim forms or deductibles to satisfy-depending on the plan.
- Emergency care is covered anywhere in the world.
- Routine gynecological care is typically available without a referral. Coverage is typically provided for pregnancy, including prenatal, delivery, and post-partum care.
- HMO's have a large focus on preventative care and keeping members healthy.
What is a POS?
POS (Point of Service): These health plans are a hybrid of the HMO plan. With a POS plan, participants can elect whether to receive treatment within the plans managed HMO network, or go outside the network, to receive benefits. Essentially, it is the same as a HMO plan but has out-of-network benefits.
POS Features:
- Insured's have the ability to control out-of-pocket expenses by seeing participating primary care physicians but freedom to go elsewhere is desired.
- A referral to a network specialist is needed from a primary care physician, but a referral is not needed for non-network services.
- Small co-payments for network services; deductibles and percentage participation for non-network services.
Preventative care usually covered.
What is a PPO?
PPO (Preferred Provider Organization): These health plans are usually the most expensive with the lowest benefit amount. The PPO plan has in and out-of-network benefits. There is an array of PPO plans to choose from, such as higher deductible and coinsurance plans, should there be a desire to lower the monthly premiums. Generally, PPOs provide a larger network of Healthcare Providers than a HMO or POS. A PPO plan does not require a Primary Care Physician (PCP) or referrals.
Advantages to a PPO: Typically, you will have a larger network of Healthcare Providers than other plans. Also, PPO plans do not require a Primary Care Physician or referrals.
PPO Features:
- PPO providers are paid on a fee-for-service basis as their services are used.
- Insured's that use a network provider pay lower deductibles or copayments than if they use the out-of-network benefits.
- Usually employees do not need referrals to see specialists.
Usually no claims paperwork if insured uses a network provider.
What is a HSA?
HSA (Health Savings Account Plans): This plan helps you take control of your health care expenses with a tax-favored savings account and quality medical coverage. This plan combines high-deductible medical insurance with a tax-favored savings account. Money deposited in the savings account helps pay the high deductible. Once the deductible is met, the insurance starts paying. Money left in the savings account is yours to keep.
Take the money currently spent on existing insurance and put a portion towards a qualified higher-deductible plan, with the remainder going into a tax-favored savings account.
Use the savings account to help pay the deductible; then higher deductible medical pays for the remaining covered medical expenses. The money left in the savings account is yours to keep!!
HSA Contributions: 100% tax-deductible from gross income
Health Premium: 100% tax-deductible in 2003
Medical Withdrawals: Tax-free
Interest Earned: Tax-deferred; if used for qualified medical expenses, tax-free
Nonmedical Withdrawals: Income tax + 15% penalty tax (under age 65)
Income tax only (over age 65)