11/28/2021
The Basics of Open Enrollment: Key Terms To Know:
HDHP
- a High Deductible Health Plan is a plan with a higher deductible than a traditional plan. The monthly premium is usually lower, but you pay more health care costs for yourself (deductible) before the insurance company starts to pay its share.
A HDHP can be combined with a health savings account (HSA), allowing you to pay for certain medical expenses with money you and/or an employer may contribute but is free from federal taxes. Offers out of network options, but at a higher cost. Normally does not need a referral.
HMO
- a Health Maintenance Organization is a health insurance plan that provides healthcare services through a limited network of providers. Does not allow out-of-network services unless there is a medical emergency. Requires referrals. HMOs offer the least flexibility but usually have the lowest monthly costs.
PPO
- Preferred Provider Organization offers a network of healthcare providers you can use for your medical care. These providers have agreed to provide care to the plan members at a certain rate. This type of plan offers flexibility due to a larger network and typically the most expensive monthly premium. Offers out of network options, but usually at a higher cost share. Normally does not require a referral.
POS
- a Point of Service plan, like an HMO, requires that you get a referral from your P*P (Primary Care Physician) before seeing a specialist, but unlike an HMO, a POS plan covers out-of-network providers for slightly higher premiums. It's still more cost effective to stay in network, but this is an important difference if you are managing a condition and one or more of your doctors are not in network
EPO
- an Exclusive Provider Organization is a managed care plan where services are covered only if you go to doctors, specialists, or hospitals in a plan's network (except in an emergency). Usually more flexible than an HMO. Normally does not require referrals.
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Parker Benefits Consultants | 139 followers on LinkedIn. Healthcare Benefits Consultant (Individual & Business) | If you're like most of us, employee group and/or individual healthcare benefit plans often seem like a foreign language. It can be difficult to understand your options and without guidan...
