Understanding Your Benefits
When you choose a healthcare plan, you’re deciding how you, your employees and your families access doctors, hospitals, and other medical services - and how much you’ll pay. Most plans fall into one of these common types:
HMO (Health Maintenance Organization)
You pick a primary care doctor who coordinates your care. Referrals are usually needed to see specialists.
Coverage is limited to in-network providers, except in emergencies. Usually the lowest cost option, but with the least flexibility.
ACO (Accountable Care Organization)
A network of doctors and hospitals that work together to coordinate care. Focus is on quality of care and avoiding unnecessary costs.
You may still have to stay in-network, depending on the insurer. Best for: Patients who value coordinated care and preventative health.
EPO (Exclusive Provider Organization)
A middle ground between HMO and PPO. No referrals needed for specialists, but you must stay in-network (except for emergencies).
Lower costs than POS or PPO, but less flexibility if you travel or want to see out-of-network providers.
POS or PPO (Point of Service or Preferred Provider Organization)
No referrals needed to see specialists. You can see both in-network and out-of-network providers, though out-of-network care costs more.
More flexibility, but higher premiums and deductibles than HMOs.
Health Benefit Resources
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