Written by: AEIS

What is EPO: Exclusive Provider Organization?

If your health insurance is an EPO plan, it works very similar to a PPO except there is no out of network coverage at all. So long as someone is within your network, you can see them - even without a referral.

What is POS: Point of Service?

It can be helpful to think of these types of insurance plans a bit like a combination between a health maintenance organization and a preferred provider organization. If you want to see a specialist, you'll need a referral from your PPC. However, you will also be able to get some level of care when seeing someone out of your network. It's just that you will likely have a higher co-pay than you would with in-network care.

What is HDHP: High Deductible Health Plans?

This is a type of health insurance plan that allows members to contribute tax-preferred dollars into a health savings account (HSA) which can be used for qualified medical expenses. The caveat however is that the member must pay for all expenses out of pocket until the high deductible has been satisfied, even for things that wouldn’t normally be subject to the deductible such as office visits.  An HDHP plan can be within a HMO, PPO, EPO or POS network. 

What's the Difference Between HMO, PPO and HDHP?

The major difference between an HMO, and a PPO, comes down to access to providers. HMO’s have narrower networks of providers and members must generally stay within the specific medical group of their primary care physician. PPO’s allow members to see providers in a variety of medical groups and can see specialists in network without a referral. For multi-state employers, your employees will need a PPO in order to be able to get coverage outside of the employer’s primary state. 

Likewise, both HMOs and PPOs typically have HDHP options available. An HDHP isn't necessarily a unique type of plan; it is moreso a designation for various plans that can be paired with an Health Savings Account. .

How to Choose the Right Plan for My Company

You'll also want to consider things like the quality of the doctors who are in-network for a particular plan, and whether things like being able to go outside a network is important to people. For multi-state employers it is critical to make sure your plans have adequate network access for the states they live/reside in.

Really, what you're trying to do is balance the amount of money you'll be paying for healthcare (which is traditionally one of the biggest expenses for any organization) and the amount your employees will be paying, coupled with the quality of the experience you'll be able to offer them. It is often possible to offer a variety of different plan types in order to suit the needs of your diverse team. Because of that, resist the urge to cram your company into a "one size fits all" box and really take the time to come up with a solution that is every bit as unique and specific as your workforce is. It would be a mistake to offer them something generic and say "most other businesses are fine with this so you should be, too."

If you know you need to re-think your business' approach to health insurance coverage but aren't sure where to begin, don't worry - the team at AEIS is here to help. We'll get to know your business and its employees on an intimate level, making sure we understand what everyone's preferences are and what they truly need. We'll help make sure you understand all available options and will ultimately sit down and help you make the best decision possible given your workers.

If you have any additional questions about the differences between concepts like an HMO, PPO, EPO, POS, and HDHP when it comes to health insurance, or if you'd just like to talk to someone about your business' own needs in a bit more detail, please don't hesitate to contact the team at AEIS today.