How Do I Know What Health Plan to Choose for My Employees?


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Providing your employees with excellent health care benefits is an effective way to attract and retain skilled workers. However, with the multitude of insurance options it can be challenging to find the best one for your company. A number of factors will come into play when making a decision, such as how many employees you have, the age of said employees, and your benefits budget. Use this detailed health plan comparison to learn more about employee health plans, what they cover, and the ideal candidates.

Health Maintenance Organizations (HMOs)

Since the establishment of the Health Maintenance Organization Act of 1973, Health Maintenance Organizations (HMOs) have become one of the most popular health plans available. HMOs are also one of the least expensive options. However, with the lower cost come fewer available networks and less freedom for choosing hospitals and doctors. With an HMO, patients must see a primary care physician (PCP) before they can visit a specialist. HMOs do not cover out-of-network providers with the exception of emergency hospital visits or life flights. Another exception includes physicians within a hospital that bill separately and accept your insurance.

With a HMO, members may not be required to pay a deductible before their coverage begins. Co-payments are usually minimal or may not exist. Most HMO plans have an out-of-pocket limit and no deductible. Also, you are generally not responsible for submitting your own claims to the insurance company which can be a convenient perk. An HMO plan may be right for your employees if you looking to maintain low premiums, want a plan that does not have deductibles, or if you want adequate preventative care services for your employees, such as immunizations and checkups.

Preferred Provider Organizations (PPOs)

Preferred provider organizations (PPOs) offer the most amount of freedom in terms of choosing health care providers. However, this freedom comes with a higher cost. In fact, PPOs are one of the most expensive types of health insurance available for employees. Unlike a HMO plan, a PPO allows members to see a specialist without getting a referral from a PCP. Plan members are also allowed to see out-of-network doctors if they choose. However, a PPO typically involves more paperwork as many providers require payment upfront and members must apply for reimbursement for the services rendered.

a PPO health insurance form that an employer is filing after having made an extensive business health plan comparisonWith PPO health insurance, members typically have an annual deductible that they must pay before the insurance company will begin covering their medical bills. Members may also have a co-payment which typically ranges from $10 to $30 based on the service provided. Alternatively, members may be required to pay a certain percentage of the total medical bill changes. A PPO may be the right choice if you want your employees to have the freedom to choose any medical facility or provider, if you want a portion of all out-of-network claims to be covered by insurance, or if you want to avoid the need for referrals for specialists.

Exclusive Provider Organizations (EPOs)

An Exclusive Provider Organization (EPO) combines many of the features of an HMO and a PPO. Similar to a PPO, members have some freedom to choose their own health care provider. However, networks may be narrower. Having a smaller pool of providers does allow for lower premiums. In addition, EPO members do not need a referral to see a specialist. What makes an EPO similar to an HMO is that there is no coverage for out-of-network providers. If you enjoy these features of both a PPO and HMO, then EPO health insurance may be the right option for you. Consider this when making your health plan comparison.

Point of Service (POS)

A point of service (POS) health insurance plan blends together features from both HMOs and PPOs but differently than with EPOs. With a POS, members have some freedom to choose their health care provider, but must see a PCP for a referral if they wish to see a specialist. However, like PPO plans members have the option to see out-of-network providers but may have to pay more for these services. When making a health plan comparison, a POS plan may be a good option for you if you do not mind paying monthly premiums and want the option to see out-of-network providers.

High Deductible Health Plans (HDHPs)

A high deductible health plan (HDHP) is essentially a HMO, PPO, EPO, and POS, but functions differently when it comes to its pay structure. Who a member will see for health care services is based on the primary plan type. In general, PPOs are the most open while HMOs are the most restrictive. HDHPs generally have the benefit of lower premiums but with a higher deductible. In addition, out-of-pocket expenses may also be higher. For this reason alone, a HDHP insurance plan is often best for people who have minimal to no health problems.

a doctor who will speak with a business owner with the help of a benefits consultant about different health plans he can choose from for his employees for his employeesThere are also considerations to make when deciding if a HDHP is right for your business. One of the great things about this insurance plan is the ability to pair them with a health savings account, or HSA. With an HSA a policyholder is able to make tax-free contributions to and from a savings account, but there are some contribution limits. However, policyholders have the option to contribute additional funds up to any limit of their choosing. In 2017, the tax-free contribution limit for individuals was $3,400 while the contribution for families was $6,750.

Contact a Professional Benefits Consultant

Group health insurance is one of top benefits potential employees seek when looking for a new job. By creating a health plan comparison and offering an attractive health plan, you can appeal to talented individuals who understand the benefits of having adequate health insurance. However, as not all health care plans are the same it is important to do your research and perform a detailed health plan comparison. Want to know more about these different health care plans for employees and which is right for your company? Contact the benefits consultants at BBG to learn more about your health plan insurance options, making a comprehensive health plan comparison, and how to sign up for a plan.