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PPO, HMO, EPO and POS plans: Which One is the Best for Your Employees?

According to the laws of the state, employers must provide medical insurance to their employees. A suitable medical care plan to offer your employee is the one that meets the needs of the employee. 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 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. You will pay co-payments and deductibles, but the amount will be determined by the premium rates of your state and the plan coverage.

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. The insured pays a larger portion of the medical bills from his or her pockets although the PPO plan covers a percentage of the expenses. PPO also charges deductibles and co-payments. PPO deductibles are higher than the HMO deductibles.

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 limited to doctors and hospitals that are in the HMO network when in need of medical care. HMO plan does not compensate the insured if the medical services are offered by doctors and hospitals that are outside the HMO network. If the insured needs emergency medical care yet he or she is far away from the immediate doctor and hospital that is in the HMO network, the HMO plan will cover the medical expenses.

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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