Unlike personal health insurance, which you buy as an individual, group health insurance is insurance coverage that is made available to a group of employees through a job or a union. Group insurance is usually less expensive than individual insurance and can't limit your coverage based on a pre-existing condition for longer than 6 months. There are several different types of group health insurance, and your group health insurance may be limited to one particular plan or offer you a choice of several different types of plans.
HMOs
Health Maintenance Organizations, better known as HMOs, allow you access to a specific network of member providers, meaning you'll have to choose your doctors from a list of network physicians. Under an HMO plan, you have no deductible, or minimum amount you have to pay before your insurance starts covering the cost---you pay a pre-determined amount called a co-pay at doctor and specialist visits. An HMO won't cover any medical expenses that you incur out of network, so it's important to confirm with your doctor's office and with your insurance provider that a particular physician is in your network before you schedule your appointment. In some cases, HMOs require you to choose one doctor, called a primary care physician. If you have a primary care physician under an HMO, you must get a referral from your primary care physician before you can see a specialist or have any specialized medical tests done. If you don't get a referral first, your HMO may not pay for those medical expenses.
PPOs
Preferred Provider Organizations, or PPOs, are similar to HMOs in that they work with a specific network of health care providers. Unlike HMOs, however, PPOs allow you to choose a health care provider who is not on the list of affiliated doctors, a process called "going out of network." You also don't need a referral to see a specialist if you are in a PPO. If you see doctors in the PPO network, you are responsible for a lower co-pay. Seeing doctors out of network may require a higher co-pay or deductible, an amount of money you have to pay out of pocket before your PPO will cover the cost. PPOs generally have higher monthly premiums than HMOs.
POSs
Point of Service Plans, POSs, work like a combination of HMOs and PPOs. As in an HMO, members of a POS choose a primary care doctor, whose referral they need to see other specialists. Your primary care doctor can refer you to specialists both in and out of network---as in a PPO, your co-pays may be higher and you may have to meet a deductible when you see a health care provider who is out of network.
HDHPs
High-Deductible Health Plans, or HDHPs, are also known as catastrophic health plans because they only cover medical costs after you've paid a fairly substantial deductible, usually several thousand dollars, out of pocket. People often use HDHPs in conjunction with a Health Savings Account (HSA) that lets you set aside pre-tax money to cover medical expenses.
Member Comments