Traditional Employer Sponsored Plans

These are the plans that have been most commonly associated with medical benefits. Employees may find them familiar and easy to navigate and requires only minimal consumerism on their part.

Fee-for-Service

Fee-for-Service is health coverage that reimburses health care providers for services for employees. It tends to be the most costly option for employers.

Primary Care Physician:
This is not required. Employees can choose any provider.
Network of Providers:
No networks. Employees can choose any provider.
Referrals:
Not required.
Deductibles, Coinsurance, Copayments & Claim Forms:
Deductibles and coinsurance may be required. Claim forms may be used.

Health Maintenance Organization (HMO)

HMO plans cover services performed solely by providers in a network. This tends to be a low cost system, but is more restrictive than other plans.

Primary Care Physician:
Required; the PCP coordinates all medical care and must make referrals to specialty providers for employees.
Network of Providers:
Services by out-of-network providers are not typically covered under the plan.
Referrals:
Required; PCP coordinates all medical care.
Deductibles, Coinsurance, Copayments & Claim Forms:
May require employee cost-sharing through deductibles, co-pays or coinsurance.

Preferred Provider Organization (PPO)

PPO plans have a network of providers, but also allows use of medical providers outside of the plan’s network (typically with greater employee cost-sharing). Referrals may not be required. PPOs are more flexible than an HMO, but also generally more expensive.

Primary Care Physician:
Not typically required. Some PPO vendors offer incentives for employees to visit a PCP to coordinate medical care.
Network of Providers:
There is a network, and the plan allows for use of out-of-network providers with greater cost-sharing by employees.
Referrals:
May not be required.
Deductibles, Coinsurance, Copayments & Claim Forms:
Coinsurance, deductibles and co-pays are the standard; usually lower when using in-network providers.

Point-of-Service Plan (POS)

POS plans combine elements of an HMO and PPO. Each time employees need health care, they can choose how it will be received. If an employee initially sees a PCP and stays in-network, then more substantial benefits will be received versus not seeing a PCP first.

Primary Care Physician:
Required when accessing HMO-like benefits of the plan. Not required when accessing PPO-like benefits of the plan.
Network of Providers:
Employees must stay in-network.
Referrals:
Required for the HMO portion of the plan; not required for the PPO portion.
Deductibles, Coinsurance, Copayments & Claim Forms:
No deductibles; minimal coinsurance or co-pays for HMO portion. Deductibles, coinsurance and co-pays are typical for the PPO portion – lower for in-network providers.

High Deductible Health Plan (HDHP)

A high deductible health plan is often paired with a tax-advantaged account to pay for medical expenses. The most prominent options are Health Reimbursement Arrangements (HRAs) and Health Savings Accounts (HSAs) used in conjunction with savings accounts.

Primary Care Physician:
Not required but there are incentives for using providers that are reasonably priced.
Network of Providers:
Not required but are offered to bring savings to employers and employees.
Referrals:
Not required.
Deductibles, Coinsurance, Copayments & Claim Forms:
Typically low or no coinsurance after the deductible is met. Deductibles are substantially higher than other plans.