| Health Plans |
1. Group HMO Plans- Generally:
| HMO Plans require the member to use the providers (physicians, hospitals, pharmacies, other ancillary providers) in the HMO’s contracted network. The member is required to select a Primary Care Physician (PCP), who provides the member with referrals to network specialists. There are no out-of-network benefits, except in the case of emergencies. HMO plans typically use a co-pay structure, with the member paying a set amount to the provider (i.e. $10.). Group HMO Plans can be priced on a composite or average rate (cost) per employee. |
2. Group PPO Plans- Generally:
PPO Plans require the member to use the providers in the PPO’s
contracted network. However, PPO Plans do not require the selection of
a PCP and typically offer out-of-network benefits at a reduced level.
PPO Plans are structured with a deductible and co-insurance, paying
benefits at a set % of the total bill (after the deductible), with the member
assuming responsibility for the balance (i.e. $500. deductible; 80%/20%
plan). Group PPO Plans can be priced on a composite or average rate
(cost) per employee.
contracted network. However, PPO Plans do not require the selection of
a PCP and typically offer out-of-network benefits at a reduced level.
PPO Plans are structured with a deductible and co-insurance, paying
benefits at a set % of the total bill (after the deductible), with the member
assuming responsibility for the balance (i.e. $500. deductible; 80%/20%
plan). Group PPO Plans can be priced on a composite or average rate
(cost) per employee.
3. Group POS Plans- Generally:
These plans are typically structured as HMO/POS plans where the
member can stay in-network using the HMO co-pay structure, or can use
an out-of-network provider, under the POS structure, with reduced
benefits (like that of a PPO).
member can stay in-network using the HMO co-pay structure, or can use
an out-of-network provider, under the POS structure, with reduced
benefits (like that of a PPO).
4. Self-Funded Plans- Generally:
These plans are typically best suited to larger employer groups. The
employer group selects a Third Party Administrator (TPA), to administer
the group’s plan and funds its own employee health benefits, under a
selected plan design (i.e. a PPO Plan design), and using a contracted
provider network (i.e. a PPO Provider Network). Self-Funded employer
groups sometimes purchase Stop-Loss Insurance to limit their exposure
beyond a pre-determined level.
employer group selects a Third Party Administrator (TPA), to administer
the group’s plan and funds its own employee health benefits, under a
selected plan design (i.e. a PPO Plan design), and using a contracted
provider network (i.e. a PPO Provider Network). Self-Funded employer
groups sometimes purchase Stop-Loss Insurance to limit their exposure
beyond a pre-determined level.
5. Limited Coverage Plans- Generally:
There are limited coverage plans available to groups. However, these
are usually limited to groups with a minimum number of employees
(varies). These plans typically offer limited benefits and require the use
of the providers in their contracted network.
are usually limited to groups with a minimum number of employees
(varies). These plans typically offer limited benefits and require the use
of the providers in their contracted network.
Please provide us with some basic information and we will explore
the available alternatives, and provide you with specific benefits and
costs information. There is absolutely no obligation on your part.
the available alternatives, and provide you with specific benefits and
costs information. There is absolutely no obligation on your part.
Copyright © HealthSpectrum, Inc. All rights reserved.
Your Resource to Affordable Employee Benefits
 |
| |
 |
| |
 |
| |
 |
| |
 |
| |
 |
| |
 |
| |
 |
| |
 |
| |
 |