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Group Health Insurance Plans

Written by Kathleen Gagne
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Group health insurance plans fall into three main categories. The first is fee-for-services or traditional health insurance. Under this type of plan, the carrier pays the provider directly for the balance of fees due after the participant pays his/her required portion. Participants can choose any doctor and will usually have to pay out of pocket fees up to the limit of a set deductible before the carrier pays anything. Emergency room coverage is often not included in the deductible.

Another type of plan is called an HMO. HMO plans require that the participant use physicians from a pre-determined list of providers. These plans are more focused on preventive health care and often include full coverage for such services as mammograms and annual physicals. HMOs make a lot of decisions for participants and, when a participant feels that none of the doctors in the network will provide the extraordinary care they need, the HMO may or may not pay the additional fees.

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A third plan type is the PPO. PPOs allow participants some choice in which providers they use. The disadvantage of a PPO is that, if participants choose to utilize the services of physicians outside of the PPO plan list, they will not receive full benefit from the plan. This is because the PPO will pay a lower percentage of the charges to out-of-plan providers.

Once you determine which kind of group health insurance plans you want to consider for your employees, you will have to discuss the individual benefits the plan offers and will need to determine what the costs for the plan will be. Make sure you find out how responsive the carrier's customer service department is and how they address your questions and concerns. You will also want to find out how long they have been providing health care coverage and how strong is their financial backing. Once you have this information in hand, you will be ready to select an insurer.


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It will help you to shop around- but make sure you have a copy of your geenarl policy so that you can compare coverages and request the same type coverages, because some insurers will put minimum coverages and take some protection away from you just to beat other quotes, without taking into consideration your financial protection!