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PPO, HMO, EPO and POS plans: What Should You Offer Your Employees?

The state requires employers to offer medical insurance to their employees. A suitable medical care plan to offer your employee is the one that meets the needs of the employee. Some employees will need a primary doctor manage their health hence an HMO plan will satisfy them while those who need to get opinions of several specialists but they would rather not go through their primary care doctors will appreciate the PPO or POS plan. PPO, HMO, EPO and POS plans have been discussed in length below.

The Fee-for-Service (FFS) policy or an indemnity plan gives the employee the freedom to select the doctor and hospital to get treated. The insured aye the medical bills directly then seeks reimbursement from the insurer. It is cheaper to get the policy under your employer’s plan instead of taking it on your own. The premium rates of your state and the plan coverage will determine the rate at which the co-payments and deductibles will be charged.

Preferred Provider Organization (PPO) policy does not limit you to the doctors and hospitals that are in the PPO network when you need medical services. However, you will pay more when you get treated by doctors and hospitals that are outside the PPO network compared to those who are within the network. Although the PPO plan pays a percentage of the medical expenses, the percentage it pays is less than the percentage of the bill that the insured will pay from his or her pockets. PPO also charges deductibles and co-payments. HMO deductibles are lower than PPO deductibles.

Health Maintenance Organization (HMO) policy has the lowest premiums, co-payments, and deductibles compared to other employee health care plans. It restricts the insured to doctors and hospitals that are in the HMO network when medical needs arise. HMO plan does not compensate the insured if the medical services are offered by doctors and hospitals that are outside the HMO network. If the insured needs emergency medical care yet he or she is far away from the immediate doctor and hospital that is in the HMO network, the HMO plan will cover the medical expenses.

Point of Service (POS) policy is a combination of features that are PPO and HMO. POS allows one to get medical services from doctors and hospitals that are within and outside the POS network but the person is charged higher when the services are offered by doctors and hospitals that are outside the POS network. POS premiums are higher than HMO but lower than the PPO premiums. There are no deductibles for in-network services in POS. The POS in-network co-payments are about $10 to $25 per appointment.

There are no out-of-network benefits in the Exclusive Provider Organization (EPO) plan hence the insured ha to stick to doctors and hospitals that are in the EPO network. An employee who has long term health conditions that need a specific doctor and hospital to manage his or her health should be offered an EPO plan.

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