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Group health insurance is the benefit most valued by your
employees.
Coverage is typically available to companies with
one (1) or more employees.
The three most commonly available health plans are as
follows:
HMO (Health Maintenance
Organizations)
In an HMO you must select a primary care physician (PCP) who
coordinates your medical care with other physicians within an
HMO network of providers. Your PCP must refer you to a
specialist, except in cases of bona-fide emergencies.
POS (Point of Service)
A POS plan is essentially an HMO-like plan that allows you to
self-refer to another physician or specialist without the
approval of your primary care physician. When you do
this, however, deductibles and co-insurance charges apply.
PPO (Preferred Provider Organization)
A PPO plan allows greater patient freedom in choice
of health care providers. In this type of plan, a PCP is
not required. If you receive care from a preferred
provider (someone who participates in the health plan's network)
benefits are paid at a higher level than they would be if the
care is rendered by a non-participating provider. Upfront
deductibles and coinsurance charges may apply.
Cost
Monthly premiums for health insurance are typically
determined for each group based on employee characteristics such
as age and type of coverage selected (individual or
family). The cost of health insurance coverage is
determined two ways: (1) Community rated and (2) Experience
rated.
Eligibility
An employee is considered eligible when he or she
meets the waiting period and minimum hours worked requirements
set by the employer.
Employee participation
Insurance carriers will require a minimum level of
participation by eligible employees in a group plan.
Employers may exclude allowed waivers from the total number of
eligible employees. Of the remaining net eligible
employees, 75% must elect coverage under the plan.
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