Open enrollment is upon us
HEALTH BENEFITS UPDATE
As we enter open enrollment season for
health benefits, I thought I would take this
opportunity to outline the different types of
plans that are available in order to help members make make educated decisions with
regard to the options available.
The most common plan that our members
have is a PPO, or “Preferred Provider Organization.” Generally, these plans provide a broad
network of doctors and hospitals. For in-network
providers, there is generally a small co-pay for services. If the
provider is out-of-network, then there is a deductible and then
a percentage of the usual and customary fee for service after that
deductible is satisfied. These plans are referred to as the “Direct”
and “Freedom” plans within the State Health Benefits Plan, or
“Direct Access” in Horizon’s private plans.
KEVIN C.
LYONS
The next most common plan is the HMO or “Health Maintenance Organization.” These plans have a small co-pay for services, but there is no out-of-network benefit. Generally, their cost
is similar to the PPO plans, unless you go with a higher co-pay
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choice. If your doctors and hospitals are in the network, this
might be an option for you.
A common plan being offered now is a tiered network or EPO
plan. These plans have a much smaller network and no out-ofnetwork benefit. This is being offered as “Omnia” and “Liberty”
plans within the state health benefit plan (SHBP). They are being
offered at a 25-percent discount under the “Direct” and “Freedom” plans in the SHBP.
The last plan options are high-deductible plans. Although
they have deeply discounted premiums, the first $1,500 or
$4,000 is out of pocket, depending on the plan design that you
choose. As with all plans, your yearly physical is included at no
cost as per the Affordable Care Act.
Due to the impact of escalating premiums, it is important that
you review your options, the premium costs, and make a decision that is best for you and your family. Everyone has varying
healthcare needs and the decision is deeply personal. Please
refer to the State Health Benefits website for specific
information on each plan, or your human resources staff if you
are not in the SHBP. d