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Buying The Right Employees Health Insurance Policy

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Buying The Right Employees Health Insurance Policy

Buying The Right Employees Health Insurance Policy

There are different types of employees health insurance available for the employer to select. Businesses mostly provide employees with Group Health Insurance plans, the coverage amount being paid by the employer in most of the cases. The amount depends on the group rates of the insurance company the employer is working with and the particular health insurance chosen. In some policies, the company bears the full cost of premium while in others, it is part amount that is being shared by the company, the rest being paid by the employees.

Types Of Employees Health Insurance

The types of employee health insurance that an organization could consider for its employees are anyone of the following:

  • Health Maintenance Organizations (HMO)
  • Point-of-Service Plan (POS)
  • Preferred Provider Organizations (PPO)

Health Maintenance Organization (HMO) is a form of health care coverage in the U.S. that is available through hospitals, doctors as well as other providers. These hospitals as well as doctors and medical providers have contracts to offer health care to members for medical insurance charge that is paid monthly. HMO is a form of managed care organization which requires businesses that have employees' strength of 25 or more to provide HMO options that are certified federally.

Members at the time of joining an HMO medical insurance plan choose a doctor from a list of physicians as provided by the HMO. Family practitioners, paediatricians and internists work to provide medical care including referrals and the necessity for additional lab tests or x-rays. The aim is to do away with any needless care that would further add to the total cost of health care.

In Point-of-Service Plan (POS), there is an approved network facilities and physicians available for the policy holder to select like that of HMOs and PPOs. Hence, POS is also known as an 'open ended HMO' or an 'open ended PPO'. However, in POS plan, the policy holder can get medical care from outside the network, in addition to the services of physicians and facilities that are available within the network.

There are different types of plans available with POS that vary with the choices of facilities and physicians that are included with lower costs. For example, a new policy holder of POS at the time or enrolment is required to select a physician from the list of pre-approved doctors in the approved medical care network of the providers. The selected doctor keeps a tab on the health of the policy holder who becomes the point of service. It is this POS doctor who refers the policyholder to doctors not in the network of physicians. However, not all the claims will get coverage in full. It is only when procedures and appointments when made within the approved network health care facilities will get full claim coverage.

Policy holders of Preferred Provider Organizations (PPO) Plans can select a physician or hospital from the “preferred provider” list that would allow them to get maximum benefits. However, on visiting a physician or hospital that is not present on the list, the policyholder gets a lesser percentage coverage of the costs through PPO Plans.

An individual gets employee health insurance through the employer at the time of enrolment period. If the employee is to marry or adopt a child, then a set period of 30 to 60 days is given for the individual to change the enrolment, which is known as special enrolment period.


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