Small business owners strive to find competitive health care solutions for employees – particularly ones that improve their benefits plans. A good place to start that journey is by researching the established health care plans available for purchase. There are different kinds of plans to choose from. For example, what is an HMO plan and what are the benefits for a small business and its employee?
A health maintenance organization, or HMO, plan is a managed care health insurance plan that generally requires small business employees to make specific choices when it comes to health care providers. The HMO structure works towards coordinated care. What this means for members is that all their care is typically coordinated through a primary care physician. While some other types of insurance programs don’t require you to pick one doctor to coordinate your care, an HMO is built around the model of a primary care physician working within a specific network of medical providers.
It is the coordinated care framework that really makes the HMO plan stand out for small businesses. When they sign up for insurance, your employees will pick a primary care physician from a list provided by the insurance company. That doctor takes charge of the employee’s health care. Everything the employee needs generally goes through that one doctor. For example:
With an HMO plan, members are generally not covered if they see specialists without a referral from their primary care physician, though exceptions are typically made in case of emergency care.
HMOs usually require your employees to receive their medical care “in-network”. This means choosing a primary care doctor and hospital that has a partnership with the insurance provider. While some insurance plans (PPO plans, for example) often allow you to go out of network if you are willing to pay more toward covered care, HMOs don’t usually offer that service. If you receive non-emergency medical care outside of the network, you may be required to pay the full bill yourself.
It is often easy to stay in-network with an HMO plan, however, because of the primary care system. A primary care doctor serves as a gatekeeper that provides referrals that help keep your employees in the network with little fuss.
With an HMO plan, your employees can expect:
An HMO plan is a practical choice for the small business looking to keep costs down for employees. Some HMO plans offer low or no deductible programs. Check with a licensed insurance broker to find out if an HMO is the right choice for your small business.