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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. The employee needs a medical care plan that will meet his or her needs. The PPO or POS plan suit employees who need to visit several specialists but they would rather not go through their primary care doctors while HMO plan is suitable for employees who are contented with a primary doctor manage their health. Read on to find out more about PPO, HMO, EPO and POS plans.

The employee is free to choose the doctor and hospital to get medical services if he or she is covered by a Fee-for-Service (FFS) policy or an indemnity plan. The policy requires that the insured should take care of the medical bills then file a claim for reimbursement. 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.

Under the Preferred Provider Organization (PPO) policy, the insured allowed to get health care services from doctors and hospitals that are outside the PPO network. 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. The PPO plan pays a percentage of the medical bills, but the insured pays a larger percentage 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. The insured is not allowed to seek medical services from doctors and hospitals that are outside the HMO network. HMO plan does not compensate the insured if the medical services are offered by doctors and hospitals that are outside the HMO network. HMO plan has an exemption that it covers medical bills for emergency medical services that the insured received if he or she was far away from the immediate doctor and hospital that is in the HMO network when the emergency occurred.

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 are higher than HMO but lower than the PPO premiums. There are no deductibles for in-network services in POS. 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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