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

In most states, it is the employer’s obligation to provide medical insurance to their employees. The employee needs a medical care plan that will meet his or her needs. 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. Here is essential information about PPO, HMO, EPO, and POS plans.

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 is reimbursed by the insurer after the insured has paid the medical bills. The policy is more affordable when it is under the employer’s plan unlike when the employee takes privately. The premium rates of your state and the plan coverage will determine the rate at which the co-payments and deductibles will be charged.

You are not restricted to doctors and hospitals that are in the PPO network when you take the Preferred Provider Organization (PPO) policy. However, the charges of medical services from doctors and hospitals that are outside the PPO network will be higher than 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 has deductibles and co-payments. The rate of deductibles in PPO is higher than in HMO.

The most affordable health care plan for employees is the Health Maintenance Organization (HMO) policy because it has the lowest premiums, co-payments, and deductibles. The insured is not allowed to seek medical services from doctors and hospitals that are outside the HMO network. There is no compensation when one is treated by doctors and hospitals that are outside the HMO network. However, HMO plan will pay the medical bill if the insured needed emergency medical care but he or she was far away from the immediate doctor and hospital that is in the HMO network.

Point of Service (POS) plan has features of HMO, and PPO. 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 fall in between the HMO and PPO premiums. In POS, deductibles for in-network services are exempted. You will pay around $10 to $25 per appointment in the POS in-network co-payments.

The Exclusive Provider Organization (EPO) plan policyholder is restricted to doctors and hospitals that are in the EPO network because this policy has no out-of-network benefits. An EPO plan is the best for employees who have long term health conditions that need a specific doctor and hospital to manage his or her health.

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