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STANDARD BENEFITS EXPLANATION FOR METAL PLANS
Types of Comprehensive Individual & Family Health Plans
An HMO (Health Maintenance Organization) is one of the most affordable health plans available. You must go to doctors within the network and choose a primary care physician. However the health-care providers have contracted with the insurance company to provide health-care services at fixed rates (HMOs receive monthly payments from carriers). So they usually don't require members to satisfy a deductible before benefits take effect, and most services are covered by set, lower cost co-payments.
An EPO (Exclusive Provider Organization) is a health care benefit arrangement that is similar to a preferred provider organization in administration, structure, and operation, but which does not cover out-of-network care. As a member of an EPO, you can use the doctors and hospitals within the EPO network, but cannot go outside the network for care. There are no out-of-network benefits. An EPO is a type of health plan that utilizes primary care physicians to coordinate access to in-network medical services for plan participants. With the EPO plan, members do not need to select a Primary Care Physician (PCP), and referrals are not needed to access specialty care. Members can access any network doctor or hospital at any time and enjoy the in-network level of benefits. EPOs are structurally similar to PPOs, but EPO members cannot file claims for non-network office visits, which PPO and POS plans allow.
An PPO (Preferred Provider Organization) is a similar organization in that some health care providers are contracted to provide health care services at contracted rates, but it offers more flexibility, since most HMOs require that their members stay within their provider network. When you receive care from in-network doctors, you will save money. But you will also have coverage with any physician or specialist - even if they are not in the preferred network.
An POS (Point of Service) is an "HMO/PPO" hybrid; sometimes referred to as an "open-ended" HMO when offered by an HMO. POS plans resemble HMOs for in-network services. Services received outside of the network are usually reimbursed in a manner similar to conventional indemnity plans (e.g., provider reimbursement based on a fee schedule or usual, customary and reasonable charges).
An HSA (Health Savings Account) ( CLICK HERE FOR HSA Health Insurance BASICS ) offers maximum cost effectiveness for your benefits plan. It gives your employees an account called a Health Savings Account, or HSA, which they can use to pay for their medical care and prescriptions. The HSA is funded by a your pre-tax contributions. It also includes a Traditional Health Coverage (PPO) component, similar to a typical health plan, to help protect you against large health expenses.
We provide a choice of Health Insurance Plans for EPO, HMO, PPO, HSA's for Individuals and Families through Anthem Blue Cross, Blue Shield, Aetna, PacifiCare and many others. We realize that having all these choices of Health Insurance Plans can sometimes be a bit intimidating so please call us at (310) 678-6315 if you have any questions or if you need help.
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Barricks Insurance Services
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