A Range of Health Insurance Options

HMO – Health Maintenance Organization:
An HMO requires the insured to choose a Primary Care Physician (PCP) from a network of providers. In order to receive benefits, a referral must be obtained from the PCP prior to seeking treatment from a specialist. If a referral is not received, benefits will not be paid since an HMO does not offer an out-of-network benefit.

O/A HMO – Open Access HMO:
The benefits of an O/A HMO are the same as with a standard HMO, except that a referral is not required. When the member does select a PCP, copays for those visits and generally less. The O/A HMO does not offer an out-of-network benefit.

POS – Point of Service:
A POS requires the insured to choose a Primary Care Physician (PCP) from a network of providers. In order to receive in-network benefits, a referral must be obtained from the PCP prior to seeking treatment from a network specialist. If an employee chooses an out-of-network provider they will then be responsible for a percentage of the cost (coinsurance) after the deductible is met.

O/A POS – Open Access Point of Service:
The benefits of an O/A POS are the same as with a standard POS, except that a referral is not required.

PPO – Preferred Provider Organization:
A PPO gives the insured the choice of using a network provider and receiving a higher level of reimbursement or they may choose a non-network provider and pay a greater share of their medical expenses, typically in the form of a deductible and coinsurance. PPO networks are often larger than HMO networks, though this varies by carrier. Referrals are not required and a PCP is not selected.

HSA - Health Savings Account:
An HSA is a tax-advantaged savings account, set up by individuals, and only available in conjunction with a qualified high deductible health plan. Both the employee and the employer can contribute to the HSA, up to federal limits. The money saved in the HSA is most often used to pay for expenses incurred during the high deductible period. Any left over balance in the account that is not used for medical expenses can be carried over from one year to the next. The employee has full control over expenditures from his or her HSA.

HRA-Health Reimbursement Arrangement:
An HRA is a 100% employer funded benefit, whereby the employer agrees to reimburse employees for agreed upon benefit expenses. Most frequently, the HRA is limited to reimbursing hospital out-of- pocket expenses, but it can also be used to reduce out of pocket copays or even be used to fund a high deductible health plan. The employer saves premium dollars by purchasing less benefit, and uses a portion the savings to fund back the benefits to a better level. The employer is obligated to pay agreed upon claims, but the employee maintains no control over the funds.