THE QUINTANA GROUP

In its most basic form, group health insurance is an insurance product that provides health care benefits to those who are part of a group. Most frequently, this group is through an employer but it can also be through an association or some sort of membership opportunity such as a school, club, or professional organization.

Employer-based Coverage

If available, most people choose group health insurance coverage through an employer because frequently the employer helps offset some of the premiums costs. Some group plans may have benefits that are not available with individual insurance.  Employees contribute anywhere from 0 to 50% of the premium cost.

Types

There are three main types of group health insurance plans: the health maintenance organization (HMO), preferred provider option (PPO) and point of service plans (POS).

• HMO Plans
  In an HMO, each person must choose a physician from the network to serve as a primary care physician. In order to meet with another physician or specialist, the primary care physician must make the referral. In all likelihood, those going out of network or failing to get prior approval before seeing a specialist will not have any benefits paid.
• PPO Plans
  These group plans also have network restrictions, but do allow the patient to go outside the network. If the patient goes out of network he or she will usually pay a higher rate than if the services were provided inside the network. Also, PPO plans usually do not require designating a primary care physician or receiving a referral before seeing a specialist.
• POS Plans
  Point of service plans fall in the middle between the HMO and PPO. The patient is incentivized to stay in the network with better benefits or convenience. For example, if a patient visits a doctor or receives a service outside the network, he will have to submit his own paperwork and might be required have to pay up for the services and then get reimbursed by the insurance company.

Costs

Generally an HMO is the least expensive plan because it is the most restrictive. At the other end of the spectrum is the PPO because it is the most flexible. POS plans usually fall somewhere between HMOs and PPOs in terms of overall cost.

Choice

In some cases, there will be no choice. An employer or group may only offer one type of plan. In cases where both types of plans are offered – usually HMO and PPO – the employer requires different premiums. Overall, any health plan is generally considered better than not having one at all.

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