What Kind Of Health Insurance Might Be Offered Through My Employer?

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Asked November 23, 2011

1 Answer

The two main types of health insurance are the HMO, Health Maintenance Organization, and PPO, Preferred Provider Organization. Because there are many people participating in the plan, health care insurance through these group options is much more affordable than if the employee had to purchase private insurance.

In an HMO, the insured person is provided with a list of physicians and medical care facilities that are members of the HMO network, and the employee must choose from this list who their regular doctor will be and any care gives they need to see under the health plan, including specialists. If the insured wants to see a care giver that is not a member of the HMO network, then they will have to pay the full cost of the care given out of pocket.

In a PPO, the insured is given a list of providers just as they would with the HMO, but the insured has the option of seeing someone who is not in the network. The health plan will only pay the amount that would have been paid to a member physician and the insured must pay the difference between the covered cost and the actual cost.

In both plans, you also have the option of trying to get your preferred caregivers to join the network. This means they will only get paid the network price, but the network itself, but the benefit is that the network would then add that caregiver to the network and the caregiver can reap their benefits in the form of increased patient load.

The final option is for the employee to opt out of the group health plan and either pay for all medical services out of pocket or enroll in private health coverage, generally at a much higher price. Under private insurance, the conditions and guidelines for caregiver selection is very relaxed, sometimes to the point of having no rules regarding which caregivers are available to the insured.

Answered November 23, 2011 by Anonymous

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