Healthcare

Questions to Ask

Health plans are complex. They’re often loaded with so many details that it can be very difficult to focus on the issues that are most important for you as a small business owner. Very generally speaking, the main considerations to worry about boil down to the plan’s benefits, cost and choice. Remember these three main issues when evaluating and comparing plans.

Taking it a step further, be sure to answer the following questions when considering a plan:

Healthcare Glossary

Feel like the small print on your health plan or advice from your broker is a foreign language? Our glossary makes it easy to decipher what some of the most common terms you may come across mean for you and your business.

Point of Service (POS) Plan

A type of healthcare plan that offers cheaper service if you use doctors, hospitals and other providers in-network for your insurance plan. These plans typically require you to receive a referral from your primary care provider to see specialists, making them more flexible than an HMO plan but less flexible than a PPO.

Healthcare Plan Comparison Chart

Here's a breakdown of what various plan types typically feature. As you read about each type, just remember that today's health coverage market often offers "blends" of these traditional types. *Monthly premiums represent the total cost for a single employee (both employer and employee contributions). If you share premium costs with the employee, your business costs will be less.

HSA

Health Savings Accounts, or HSAs, are savings accounts that are combined with a high-deductible health plan. Because high-deductible plans generally cost less than low-deductible plans, HSAs are a good option for employers who cannot afford a comprehensive (low-deductible) health plan. These savings accounts are controlled by the covered employee and are intended to help pay small and routine health care expenses. Both employers and employees may contribute to HSAs.

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POS

A POS, or point of service plan, is a type of managed care plan that is a hybrid of HMO and PPO plans. Like an HMO, participants designate an in-network physician to be their primary care provider. But like a PPO, patients may go outside of the provider network for health care services. When patients venture out of the network, they’ll have to pay most of the cost, unless the primary care provider has made a referral to the out-of-network provider, in which case, the medical plan will pick up the tab.

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PPO

Preferred provider organizations (PPOs) generally offer a wider choice of providers than HMOs. Premiums may be similar to or slightly higher than HMOs, and out-of-pocket costs are generally higher and more complicated than those for HMOs. PPOs allow participants to venture out of the provider network at their discretion and do not require a referral from a primary care physician. However, straying from the PPO network means that participants may pay a greater share of the costs.

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