Group Health Insurance
If you are looking for group health insurance and are confused by the large number of different providers, plans, polices, and options available - put Plan IV to work for you! Plan IV is an independent insurance agency and a proud carrier of all the major healthcare providers such as Blue Cross Blue Shield, CAM, HAP, Humana, and Aetna. Please see below for more information on group health insurance and a list of our healthcare providers.
Before purchasing health insurance, choosing the right plan is often the most important decision you’ll make. Health Maintenance Organizations (HMO’s) and Preferred Provider Organizations (PPO’s) are two types of plans to choose from. All offer excellent access to top quality professionals but it’s important to understand the differences before you choose.
HMO plans require members to choose a primary care physician from the HMO member physicians. Your primary care physician oversees all of your general medical care needs and must be consulted before you can see a specialist, who must also be part of the HMO network.
PPO plans are similar in that you still have a network of physicians but it’s not required that you choose a primary care physician or a specialist.
HMOs typically provide no coverage for care received from a non-network provider, unless it’s for an emergency care provided while traveling away from home. In contrast, PPO members are not required to stay in the network, but there are generally higher out of pocket costs for doing so. Unless you have a strong preference for a particular doctor, it’s best to stay within your PPO network, because your PPO doctor can also refer you to a PPO surgeon if you need hospital care or surgery.
One advantage of choosing an HMO is the fact that you do not have individual or family deductible. Instead, HMO members generally pay a nominal co-payment for each visit, including hospital stays. In contrast, PPO’s sometimes require members to meet a deductible, especially for hospitalization, and may have larger co-payments than HMO’s.
So which plan is best? Of course, there isn’t one right answer; the best choice depends on your particular needs. If you are considering an HMO, be sure that your physician is in the network, unless you are willing to see another physician. If not, a PPO might be a better choice, because you can still receive partial coverage regardless of network affiliation. However, if on going Out-of-pocket costs are a major concern, an HMO is often a better choice, because there are no deductibles, co-payments are typically lower.
HMO’s (Health Maintenance Organizations)
HMO plans are a kind of managed care health insurance plan. HMO’s also are companies that have contracts with doctors and other health care providers that are directly involved in the medical treatment of their customers.
While HMO plans are generally the least expensive kind of coverage available, they are also the most restricted.
How HMO’s work:
When you sign up for an HMO, these plans require that you choose a primary care physician. You choose your primary care physician from a network of physicians and referrals must also come from a member of the network.
HMO and PPO plans, also known as Preferred Provider Organizations, use management controls such as primary care physicians lemmatization and focus on preventative care to lower the cost of health care.
Let’s take a look at some of the advantages and disadvantages of HMO’s.
Advantages
Preventative Care
HMO plans encourage members to seek medical treatment early and to have annual check ups. They are focused on wellness any HMO's offer information to their members about staying healthy.
Least Expensive Health Insurance
There is generally no coinsurance with HMO plans. Instead of a deductible, most HMO plans have a small copayment for medical services and treatment.
No Lifetime Maximums
Unlike other health insurance plans, many HMO policies do not have a lifetime maximum payout. They will pay for all your medical needs as long as you are a member.
Less Complicated Billing
Billing systems are usually less complex and consumers experience less problems.
Disadvantages
Primary Care Physician Gateway
Specialized medical attention can be more difficult to obtain with an HMO plan. You must go through your primary care physician for all care, you can't see a specialist without a referral. This helps the Company reduce expenses.
No Coverage for Out-of-Network
HMO’s generally do not cover any medical treatment received that was not in the network, even if there are no network providers in your area.
Strict Definitions
The definition for HMO plans tend to be limited. For example, an emergency room visit may only be covered if it meets the company’s definition of an emergency.
More Difficult to Change Doctors
HMO’s discourage from changing Doctors. You may be limited to change once or twice per year.
Health Savings Accounts (HSA’s) are another way to take control of your health insurance dollars. Health Savings Accounts help you save money on unavoidable expenses and build investment savings for your retirement.
An HSA works similar to an IRA, except that money is used to pay health care costs. Participants enroll in a relatively inexpensive high deductible insurance plan. Then, a tax-deductible savings account may be opened to cover current and future medical expenses. The money deposited, as well as the earnings, is tax-deferred. The money can then be withdrawn to cover qualified medical expenses tax-free. Unused balances roll over from year to year.
Anyone that has a qualified high deductible insurance plan (group or individual) is eligible for a tax-deductible HSA.
Here’s how it works.
You obtain a qualified health insurance plan with a minimum deductible of $1,200 for a single and $2,400 for a family. Each year you are allowed to deposit up to $3,050 for a single or $6,150 for a family into a HSA for 2010. You can use this savings account to pay for medical expenses or those that are not covered by your health plan. Once you meet your deductible, the health insurance covers your medical expenses as defined in your policy.
The annual maximum HSA contribution will change each year on January 1st based on the Consumers Price Index (CPI). There are no maximum limits on the account accumulation.
Similar to an IRA, if you turn 55 before the end of the tax year, you can make an additional contribution (and tax deduction) amount of $1,000. Contributions can be made by anyone on behalf of the account beneficiary.
HSA's are tax deductible, regardless of the source of your income.
There aren’t any income limits, anyone who buys a qualified high-deductible policy can open an HSA.
HSA contributions won’t effect your IRA, it’s just another way to save for retirement with the added advantage of being able to withdraw funds tax-free if they are used to pay for medical expenses.
To see if a HSA is right for you, call and a representative will design a plan for you.