Group health insurance

Types of group health insurance plans

• Health Maintenance Organization (HMO)

  An HMO is a group health plan in which physicians and medical personnel can either work directly for the HMO or under contract to provide medical care to its members. A primary care provider must provide a referral to see a specialist. There is often an emphasis on disease prevention and participation in programs for better health.

• Point of Service (POS)

  POS group insurance acts as a combination of an HMO and a PPO. You must usually use a primary care provider, but you can use other network health providers, when needed, without a referral. You may also use providers outside the network without a referral, but you will pay more.

• Preferred Provider Organization (PPO)

  In a PPO, policyholders can use any medical provider in the PPO network and pay the copayment amount for each regular service. If you choose to go to an out-of-network provider, you must often pay the doctor's fees directly and file for reimbursement from the insurance company at a greater cost. For that reason, the PPO system encourages its policyholders to see doctors and health providers within the system.

• High-deductible health plan (HDHP)

  The HDHP features higher annual deductibles and out-of-pocket maximums for single or family coverage than other traditional health plans. However, HDHPs are usually the most affordable option that employers may offer. Depending on the HDHP you choose, you may have the choice of using in-network or out-of-network providers. Using in-network providers saves money. With the exception of preventive care, you must meet the annual deductible before the plan pays benefits. Preventive care services are generally paid as first-dollar coverage, or after a small deductible or copayment.