Group Health Care

When choosing a group care plan for their business employees, employers have to make the choice between choosing an HMO group care plan or a PPO group care plan. People have to make the same group health care decision when buying their own insurance due to their job not offering benefits or being a independent contractor or whatever other reasons.

There are several differences between these two group health care options.

An HMO group care plan, or Health Management Organization, is a network of physicians, other group health care professionals, and hospitals. When purchasing group health care through an HMO, the employer is agreeing with a single network to provide all non-emergency care for the employer and all his covered employees. Each covered individual typically selects a primary care physician from within the group health care network. This specific care physician coordinates the individual’s basic health care from regular physicals to routine illnesses, specialty care, and hospitalization.

There is a small monthly premium to be paid for membership in the HMO group health care plan and there’s likely a small payment called a co-payment for each doctor’s visit and prescription. The advantages of an HMO group health care plan are many. You simply present a membership card at the doctor’s office or hospital instead of submitting claim forms. Since it’s a fixed fee, it is in the HMO’s best interests to make sure preventive care is available. The costs tend to be lower and more predictable. And there is no annual deductible that must be met before the HMO covers all health care expenses.

A PPO group health care plan, or Preferred Provider Organization, is designed to offer generally lower costs of managed care and greater flexibility of traditional health care plans. In exchange for a fixed monthly premium, a PPO group health care plan will offer health care within its own network of physicians. However, those with a covered personal health care plan can select a primary care physician and specialists from outside the network. This results in the employer and covered individuals paying higher co-payments and coinsurance though.

PPO group health care benefits include: lower costs when using the PPO’s network, the freedom to consult any specialist even those outside the network, no requirement to select a physician within the PPO network, limited out-of-pocket expenses, and some PPO group health care plans are eligible for Health Savings Accounts.

It’s up to the employer to decide which group health insurance option is right for his business.