Next to pay rate, a quality benefits package is one of the most important factors that influence employee happiness and satisfaction in the work place. At Taylor Online Benefits we craft comprehensive group benefits offerings that fit the budget while delivering the best possible coverage to individuals, groups and employees.
Before making a decision on behalf of your staff or group members, it’s important to understand the options available and what the differences are between them. Let’s take a look at some of the basics of group health insurance options and what the terms actually mean.
An HMO is a type of plan that limits your doctor choices to a network of physicians that are contracted within a certain organization (think Kaiser), often around a certain service area or job. You can still see medical professionals outside of your network, but typically with a much higher cost. HMO’s require selecting a primary care physician, who then writes a referral for any specialized services.
A PPO has a list of medical providers that they “prefer,” but you are not limited to only those doctors, nor is a referral required to see a specialist. Going outside of a PPO network usually means paying the full cost out of pocket, filing for reimbursement and a lesser benefit payment from the insurance.
An HSA is one way of offsetting the costs of a high deductible, especially for employers offering benefits. Sometimes it’s more cost effective to offer a high deductible health plan in combination with an HSA account that offsets the costs of care for employees. Since HSA’s are tax-exempt, it’s a great way to cover qualified medical expenses without a huge out of pocket spend down. For information on yearly contribution limits, see this document from the IRS.
A Point of Service plan is somewhat like a mix of an HMO and PPO. Like an HMO, employees choose a primary doctor from within a network. With a referral, however, patients can choose to see a health care professional outside the network without having to pay for the full cost out of pocket.
Fewer than 25 employees – Information for small businesses with less than 25 employees including key changes and important aspects of the Affordable Care Act.
Up to 50 employees – Similar resource as above, but for businesses that maintain between 25-50 employees. For businesses with more than 50 employees, see this link.
California Business & Economic Development – The California Governor’s Office business site has information about economic development and job creation resources for business owners in the state.
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