If you’re a small business owner in Atlanta, you might be considering offering group health insurance for your employees. Unfortunately, all the terms, abbreviations, acronyms, and so on can be bamboozling. In considering what sort of plan you want to offer, you’re wondering what the difference is between an HMO (Health Maintenance Organization) plan and PPO (Preferred Provider Organization) plans. Well, apart from having different letters, that is. Anyways, we’ll explain what HMOs and PPOs are and why they’re different.
What is a Health Maintenance Organization (HMO) plan?
One type of Atlanta group health insurance is offering an HMO plan to your employees.
Basically, the Health Maintenance Organization creates a network of healthcare providers that work with them. These providers have agreed to be paid set amounts for the services they provide. This means that the HMO is able to keep costs fairly low for people who are on these plans, making it an affordable health insurance option. The premiums and copays (fees for visiting a doctor or specialist) can be more affordable than those of a PPO plan.
However, there’s a catch:
Remember how we mentioned the network of healthcare providers? If your employees are on an HMO insurance plan, they can only go to doctors who are in that network in order for expenses to be covered. They can’t see a doctor who is out-of-network unless it’s a complete medical emergency.
So, employees could see lower costs as far as premium, copay, and out-of-pocket expenses, but they lose the flexibility of being able to see whichever doctor they please.
Another thing about HMO plans is that the employee will most likely to be required to choose a Primary Care Provider from the network provided. This doctor will become their doctor, who they’ll go to for check-ups, when they get sick, and so on. And if there’s ever a time that they need to see a specialist, the Primary Care Physician would refer them to a specialist in-network. (The referral is a must – kind of like a Golden Ticket.) The specialist’s care would be covered after the copay and deductible are met by the employee.
So, HMOs could work for your employees if they’d rather pay lower premiums and they’re okay with being limited to choosing doctors in the network. Generally, HMOs can work for people who don’t need more than basic care in the form of checkups, vaccinations, and so on.
(We can help you get the Atlanta group health insurance that’s right for your business. Get started with your quotes by filling out our online form or giving us a call today.)
What is a Preferred Provider Organization (PPO) plan?
Another Atlanta group health insurance option is to offer a PPO plan to your employees.
A PPO plan also consists of a network of healthcare providers, and these providers have agreed to offer set rates for their services to members. However, the employee would have the option to go to a doctor or hospital that’s out of that network. (Although choosing one of the in-network providers will most likely cost less.) Basically, you can go to any doctor, in-network or out-of-network.
These plans offer more flexibility and options as far as doctors go, but the premiums can be higher, as can the copays. (But, like we mentioned, choosing an in-network doctor can help save money.) These plans usually require enrollees to pay a co-pay when they visit a provider, and there may be an annual deductible that needs to be met before insurance will cover certain claims. There are more options with these plans and it can be easier to see a provider when away from home or if there’s an urgent medical situation.
Another way that these plans offer more flexibility is that the employee doesn’t have to choose a primary care physician and don’t need a referral to see a specialist. They can just go without needing a primary care physician to act as a liaison. If you offer a Preferred Provider Organization plan as group health insurance for your small business, employees would most like to be able to keep their current doctor, which is helpful if they wouldn’t want to switch.
So, PPOs can provide more flexibility and choices for your employees since they don’t have to visit an in-network health care professional, but they’re often a little more expensive. It’s a trade.
And that’s the difference between an HMO plan and a PPO plan. When selecting Atlanta group health insurance for your small business, it’s important to consider what your employees would prefer and how the plan will help them get the care they need. Your employees need group health insurance that will work for them.
If you’re looking for small business health insurance, we can help. We’ll go over your options for Atlanta group health insurance and help you find the right benefits package for your employees and your business. We can also help you get workers’ comp insurance, general liability insurance, and more. Get started with your Atlanta business insurance quotes by filling out our online quote form or calling us today.