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The following questions can help you decide which plan is right for you or your family.

Q. Should I select an HMO or PPO?
A. To fully answer this question we need to compare the benefits of each type of plan:

HMO Plans:
Are a type of health benefits program that usually has the lowest out-of-pocket costs when you and your dependents access care. HMOs agree to provide all of the health care for you and your family members in exchange for a fixed monthly premium and low per-visit copayments. HMOs usually require you to select a primary care physician, generally a family practitioner, internist or pediatrician, who is part of their network. A referral from your primary care physician is usually required to see a specialist other than an OB/GYN.  There is no out of network benefit unless there is an emergency and there is no access to a provider who is not contracted with the HMO network.

PPO Plans:

This type of healthcare plan offers greater flexibility to choose your doctor or hospital while still controlling your healthcare costs. With a PPO plan, you may lower your copayments and save money by accessing care from a provider in the Preferred Provider network.  You can self-refer to any provider in the network without first obtaining a referral from a primary care physician.



If you are okay with a restricted provider list and no out of network access.

If you like freedom of choice for access to in or out of network providers.

If you do not mind getting a referral to a specialist.

If you want to self-refer to a specialist.

If you want lower out of pocket costs when accessing care.

If you are likely travel often out of the service area.

If you do not want to worry about when your deductible or coinsurance will apply.

If you would like access to a large choice of in network providers.

Q How do I lower my premium?
A. High deductible health plans can save you money on your monthly premiums and help protect against catastrophic injury.  Deductibiles and out-of-pocket costs for these plans are generally higher than most HMO and PPO plans.

Q Do you want fixed amounts for doctor’s visits?
A. Copay plans can give you the security of a predictable, fixed payment for each medical care office visit.  The amount of the copay varies and some plans limit the number of visits you can have a year to reduce costs.

Q How can I get a tax advantage?
A. Health Savings Account Plans (HSA) allow you to get the most from your health-care dollars.  These plans are coupled with qualified high deductible health plans.  The plan allows you to deposit the money you save on premiums into an interest bearing account that can be used for medical expenses.  See HSA for more information and questions and answers.

Q. How do I determine maximum out-of-pocket costs in the event of a catastrophic event?
A. There are 2 possible answers to this question; one figure for "In Network" coverage and one for "Out of Network" coverage. "In Network" coverage is cheaper as you are using your local doctor and facilities which are already approved by your insurance company. "Out of Network" coverage is when you require medical attention when you are away from your home network such as if you suffered an injury while travelling etc. For this reason Out of Network fees are higher.

To calculate your total out of pocket costs you simply need to look up your plan's "Out of Pocket Maximum" for both "In Network" and "Out of Network" rates.

Q. What insurance company is right for me?
A. When selecting the right insurance company you want to evaluate them on the following factors:

  • What is their rating with AM Best or Standard & Poors?
  • Are my doctors on the insurance provider's network?
  • Do they offer the type of plan I am looking for (i.e. HMO, PPO, student, temporary etc.)?
  • Do they support HSA/Health Savings Accounts?
  • Do they offer national network coverage for Individuals that travel often?
  • Do they support the type of prescriptions I need?
  • Do their plans cover mental health, chiropractors or other alternative medical treatments?
  • Do they offer coverage and/or discount plans for Dental and Vision?

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