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. Employees who would love to have a primary doctor manage their health need HMO while those who visit several specialists but they would rather not go through their primary care doctors will take PPO or POS. Here is essential information 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 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.
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 are served by doctors and hospitals that are outside the PPO network than 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. In PPO you will pay deductibles and co-payments. PPO deductibles are higher than the HMO 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. The insured will be denied compensation when he or she gets medical services from 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) policy is a combination of features that are PPO and HMO. The insured is not restricted to get medical service from doctors and hospitals that are within the POS network, but he or she 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. POS does not charge deductibles for in-network services. The POS in-network co-payments are about $10 to $25 per appointment.
Exclusive Provider Organization (EPO) plan does not allow its member to use doctors and hospitals that are outside the EPO network because there are no out-of-network benefits. An EPO plan suits an employee who has long term health conditions that need a specific doctor and hospital to manage his or her health.