Nationwide, insurance carriers are making ongoing efforts to develop and perfect their Small Group solutions to suit businesses as unique as yours. Because no two companies are the same, carriers offer a number of product options, each unique in terms of coverage, provider choice, and price point.
Health Management Organizations (HMO)
This managed care solution offers comprehensive major medical coverage, at an affordable rate to both employer and employee. Members select a Primary Care Physician, who will act as coordinator for all care that member receives.
Preferred Provider Organizations (PPO)
A more liberated approach to managed care, PPO members are encouraged to seek in-network care, but are free to choose any physician and do not have to get a PCP referral to receive benefits. Some PPOs offer out-of-network benefits, but at a higher payout percentage.
Point-of-Service Plans (POS)
This compromise between an HMO and PPO offers the security and affordability of an HMO, but with the freedom of choice celebrated in a PPO. POS members are encouraged, but not required to pick a PCP, and in-network treatment is rewarded with a lower pricing structure.
Self-Directed Health Plans (SDHP)
SDHPs represent a transition towards consumer-directed health care, as they place an increased level of control in the hands of the plan member. Members are allotted a certain allowance for healthcare expenses, and may apply funds from that source to copayments and deductibles as they see fit.
Fee-for-Service Plans (Indemnity)
These traditional indemnity plans offer the largest level of employee freedom, but typically at the highest price point. Members can choose a physician in or out of their provider network, and their expenses are paid at a predetermined rate. Any costs beyond that rate must be resolved by the member.
Prescription Plans and Policy Add-Ons
Many insurance companies offer Prescription, Dental or Vision coverage as an enhanced benefit. These policies are typically added on to the standard group medical product, and may come at a discounted rate based upon group size. Depending on the carrier, the attachment of these suppliments may be contingent upon the percentage of employee participation.
