HMOs

Determine whether HMO health insurance is the best choice for your business

HMO health insurance is one of a number of options among managed healthcare plans. HMOs, also known as Health Maintenance Organizations, provide a structured healthcare plan that maintains patient treatment and care by establishing guidelines for healthcare providers.

HMOs are designed to provide full-spectrum healthcare at low cost. HMO groups contract with specific doctors and hospitals and, because of the number of patients, can negotiate for cheaper healthcare rates. There are a number of benefits in providing an HMO option for your employees:

1. If you pay for your employees' health insurance, going with an HMO will lower monthly insurance premiums.

2. You employees will only pay small co-payments to providers at time of service, rather than full payment of their bill upfront.

3. Using HMO healthcare can result in discounted overall healthcare costs.

Compare HMO quotes and choose the best plan for your business needs

The provisions of HMO coverage varies by provider. Typical HMO quotes will include an 80/20 or 70/30 policy, meaning that the HMO pays 70% to 80% of the bill and the covered person is responsible for the remaining 20% to 30%. Additionally, the majority of HMO plans require a yearly deductible for each individual and for the entire family. Go with an HMO plan that gives your employees multiple options that will fit their physical and financial needs. Keep in mind that, if you're paying the premiums for your employees, you need to decide on a plan that your business can afford as well.
Business.com for a list of other HMO providers.

Weigh the pros and cons of HMO health insurance

Before you settle on providing HMO health insurance to your employees, be sure that the benefits outweigh the disadvantages for both your staff and your business. The major benefits include healthcare costs at a discount (as mentioned above), as well as less hassle with medical bills. The cheaper premiums also mean less cost to your business. However, your employees must use HMO doctors within the established network. Additionally, employees can't receive treatment from a specialist without a referral from their primary care physician, which can be a hassle for someone with an illness such as cancer.

Obtain a list of providers and help employees choose a PCP for their HMO

Once you decide to go with HMO healthcare, you need to find out who the in-network providers in your area are. Additionally, HMO groups require insureds to select a primary care physician (PCP) when they establish their health insurance plan. It is important to look at the PCP's accepting new patients in your area prior to signing up for coverage so you can inform your employees about available doctors. Otherwise your employees will simply have to randomly choose a PCP from a list that the insurance company provides.

• The law requires managed care plan insurance companies, such as HMO and PPOs, to provide their clients with a description of the plan. This information should include thorough information on the coverage under the plan and how to appeal the insurance company's decision on that coverage.

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