Group Health Insurance Experts

A Health Maintenance Organization (HMO) requires group members to obtain their health care services from doctors and hospitals affiliated with the HMO. Generally with an HMO members generally are required to designate a primary care physician who treats and directs health care decisions and who coordinates referrals to specialties within the HMO network. HMOs offer access to a comprehensive package of covered health care services in return for a prepaid monthly amount (or "premium"). Most HMOs charge a small co-payment depending upon the type of service provided. . 

 

A Preferred Provider Organization (PPO) does not require group members to designate a particular provider, however, if they use providers within their network, they will save the most money on their healthcare services. If providers outside of the network are used, it is possible that those services may not be covered at all, so it is a good idea to check first with your PPO. Keep in mind that deductibles must be met on this plan before some services will be covered. PPOs generally require a co-pay for physician visits.  

 

A Health Savings Account (HSA) combines a high deductible/lower premium health insurance plan (PPO) with a tax favored savings account. Both employer and employee can contribute, tax-free to the savings account. Money in the savings account can help fund the deductible and other qualified medical expenses. Once the deductible is met, the insurance starts paying. Money left in the savings account earns interest and is yours to keep.  

 

Dual Choice are instances wherein the Employer offers eligible employees a choice between several different types of plans as described above. 

Basic Types of Traditional (Fully-Insured) Health Plans

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