Employee health insurance, what you should know

When most people think about health insurance today they think of how much money they're going to have to pay each year for medical bills, hospital bills, and other things like co-payments. Employee health insurance, what you should know is a great way to find affordable health insurance. Many employers will offer employees other alternatives to health insurance as part of their benefits package in order for them as well as their families to receive medical coverage.

The term health insurance refers to a variety of insurance policies ranging from doctors and hospital visits, to more specific needs like long term care or even dental coverage. Employee health insurance usually falls under the category of managed care. Terms like "fee for service", and "indemnity" are a part of employee health care plans. Fee for service plans usually offer the freedom to choose your own doctors and specialists, as well as hospitals but tend to be more expensive than managed care plans. Managed health care plans have pre-set agreements with certain doctors, hospitals, and health care providers that will generally give a wide variety of health services at a reduced cost to the customer. However, you have to stay within your network of providers and facilities to receive the best benefits. Types of managed care plans are HMOs, PPOs, and POS plans. The most common type of employee health insurance is done through managed care plans.

Managed care plans
HMOs, PPOs, and POS plans are the most widely used employee benefit programs used among employers today. Let's take a closer look at each of these managed care plans.


• PPOs/ Preferred Provider Organizations: The PPO plan resembles most closely the "fee for service" plans. There is an arrangement with a network of doctors, hospitals and other health care providers who have agreed to accept lower fees from the insurer for their services provided. This results in a lower cost to the employee unless you choose to go outside the network. In addition to using doctors and facilities within your network, doctors can also make referrals, as well as plan members making referrals to other doctors outside the plan. For many patients this is the best of both worlds.


•  HMOs/ Health Maintenance Organizations: As a member of an HMO you can receive several health benefits, including preventative care at a set monthly premium. The one rule that HMOs have is that you have to use the health care providers within the HMO network in order to get coverage. The one exception may be in the case of an emergency. There is usually a small co-pay for doctors visits, although some require none, and most HMOs will provide for things such as flu shots, check ups, etc. at a lower out of pocket cost. The catch is that you will usually have a higher monthly premium than a PPO plan. Many employees prefer this plan however because the out of pocket costs are significantly lower.


•  POS/ Point of service plans: This is really a combination of the HMO and PPO plans. The primary care doctors usually make referrals to other providers within the plan, however if a member goes outside the network the POS plan pays for the pre-determined amount of the bill. They usually have higher monthly premiums than HMOs but have much more flexibility in regards to calling a doctor if you need them.

Guidelines will definitely vary depending on what pan you decide to go with and which plan or plans your employer offers you. Considering all your options and understanding what you should know about employee health insurance is a good idea rather than just picking the one that "sounds" best.

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