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Issue March 2004                               "Keeping Businesses Moving Towards Success"

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With a traditional health coverage plan, your employees will have the most flexibility. They can see the doctors they want to see, go to hospitals all over the country, and change doctors whenever they want to. These plans are, however, more expensive and usually don't cover preventive health care like physicals, immunizations, and well-child care. There are three variations of traditional fee-for-service coverage: basic, major medical, and comprehensive. Basic covers some of the costs of a hospital room and care, but not everything. Major Medical begins where Basic leaves off, and Comprehensive is a combination of the two.

With traditional health coverage, employees will have to pay a deductible (usually $250 to $500 per year) before the insurance begins paying anything. At that point, the insurance company begins paying 80% and the employee is responsible for the remaining 20% of all medical bills. They do usually have a "cap," which is a limit on the amount the employee will have to pay in one year. Once the cap is reached, the insurance company pays the excess.

There may also be limitations on how much the plan will pay for particular services. These are called "customary fees." If an employee's doctor charges more than the average amount for a particular procedure, then that employee is responsible for the remainder of the bill.

One of the most loved and hated types of plans is the health maintenance organization (HMO). HMOs are basically prepaid health plans. With an HMO, employees can only go to specific groups of doctors that are either owned by or have contracted with the health maintenance organization.

Small co-payments of $5 to $25 dollars are made by employees for office or emergency room visits, and the services are sometimes limited. Usually employees are required to select a primary care physician (PCP) who will monitor their health and make any necessary referrals to specialists. They typically can't see a specialist unless the PCP approves and makes the referral (unless they want to pay for it themselves).

HMOs operate on the premise that if they keep you healthy and take care of small problems before they become large ones, then they'll make more money over time and people will be healthier. Because of this, they usually do cover preventive care like physicals, well-child check-ups, etc. They also usually have less paperwork for patients to fill out.

The last health insurance option is the preferred provider organization (PPO). PPOs combine the best of both the traditional insurance and HMO worlds. Like the HMO, there is a list of providers that your employees have to choose from (a network) and they must select a primary care physician. They don't have to fill out much paperwork when they go for a visit, just pay a small co-pay, and most preventive care is covered. The difference is that they can also go outside of the list of approved physicians to any doctor they want. They just have to pay more and fill out claims forms.

Click Here For A Directory Of Agents of Business Health Insurance that can help you with all your insurance needs.

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*Article by Patricia Kopp.  Visit www.creativeBUSINESSworks.com for more original content on marketing tips, sales strategies and business success.
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