Finding affordable NH health insurance for your business and providing great employee benefits is a balancing act. There are many choices of NH health insurance plans offering a range of pros and cons as an employee benefit. Below are highlights of the key health insurance plans for you to consider for your NH family or business:
HMO – Health Maintenance Organization
The HMO uses a Primary Care Physician (PCP) to direct all health care. No benefits are available outside of the provider network except when there is an emergency. HMO health insurance plans focus on wellness and preventive medicine and is the highest level of managed care.
EPO – Preferred Provider Organization
You are allowed to self-refer to any provider in the network. There is no out of network coverage under an EPO health insurance plan except when there is an emergency. Pre-authorization requirements must be met for major services. Office, ER and Rx are all covered for just a co-pay.
PPO – Preferred Provider Organization
This health insurance plan allows you to self-refer to any provider in the network. When using the in-network providers, the higher level benefit is received. This may be as much as 90% to 100% after the deductible. In-network, all office, ER and Rx are all covered for just a co-pay. The benefit level for providers out of the network is typically 60% to 80%. Pre-authorization requirements must be met in or out of network. Out of Network services usually have a lifetime maximum benefit per member (ie: $1,000,000).
POS – Point of Service
Very similar to an HMO in-network health insurance plan, it uses a “gatekeeper” (Primary Care Physician or PCP) to refer cases to other in-network providers. Deductibles usually only apply to out-of-network care. Co-insurance is either 90% or 100% for in network providers. Services received out-of-network are typically paid at the 60% to 70% level. There are exceptions such as in an emergency while away from network providers or treatment required from specialists not available in-network.
High Deductible Health Plan (HDHP)
All covered services are subject to the plan deductible EXCEPT routine preventive care which is covered in full. Generally HDHP plans do not have office or Rx co-pays. HDHP health insurance plans can be either EPO or PPO plans and can be paired with an H.S.A. (Health Savings Account). The IRS sets the annual contribution levels for the H.S.A. and the Deductible and Out of Pocket maximums under the HDHP.
This health insurance plan provides traditional coverage. The insured individual is free to use the doctor, clinic, or hospital of their choice. Both a deductible and coinsurance generally apply and there are normally no co-pays for doctor office visits.
At Eaton & Berube, we are proud to partner with Granite Group Benefits in Manchester, NH, to provide health insurance solutions throughout the state of New Hampshire. If you’re in need of health insurance, whether for yourself or your employees, call 603-269-0700 or visit www.granitegroupbenefits.com.