HMO - Health Maintenance Organization
An HMO is a type of health insurance plan that usually limits coverage to care from doctors who work for or contract with the HMO. It generally won't cover out-of-network care except in an emergency. An HMO may require you to live or work in its service area to be eligible for coverage. You will usually need a referral from your Primary Care Physician to see a Specialist, resulting in multiple co-pays. All healthcare services are managed in-network through your Primary Care Physician.
In California, the popular HMOs are Kaiser Permanente, Sutter Health Plus, Western Health Advantage, Health Net of California, Sharp Health Plan, LA Care, Molina Healthcare, and Valley Health Plan.
PPO - Preferred Provider Organization
A PPO is a type of health plan that contracts with medical providers, such as hospitals and doctors, to create a network of participating providers. You pay less if you use providers that belong to the plan’s network. You can use doctors, hospitals, and providers outside of the network for an additional cost. PPOs do not require you to select a Primary Care Physician. One of the benefits of a PPO is you usually can self-refer to a Specialist.
In California, the popular PPOs are Blue Shield of California, Health Net Life Insurance Company, and Oscar.
EPO - Exclusive Provider Organization
A managed care plan where services are covered only if you go to doctors, specialists, or hospitals in the plan’s network (except in an emergency). Under an EPO plan you do not choose a Primary Care Physician. You can receive care from any of the in-network doctors and self-refer to in-network specialists.
In California, the popular EPOs are Anthem Blue Cross, Health Net Life Insurance Company, and Oscar.
If you want to discuss options about your health insurance, we recommend speaking with an independent insurance agent like George Beach Insurance Services. We work for you the client, and not a particular big company.
When you speak about the overall well-being of an individual, it's important to note that mental health is as important as a person's physical health. There has unfortunately been a stigma that has surrounded issues of mental health, and this has often prevented people from receiving the help that they need with their issues of mental well-being. Thankfully, this is starting to change as more awareness about mental health challenges is becoming prominent thanks to a number of awareness campaigns that have been put out to the public by various mental health advocacy organizations. With the changing attitude toward mental health well-being, there's also a heightened awareness that mental health treatment needs to be covered under health insurance plans in the way that one's physical well-being is covered.
Why it's Needed
One in five teenagers and young adults suffer from a mental health condition, and less than half receive treatment. This should be a red flag to everyone out there about how pressing this issue currently is. This is also a clear signal as to why it's so important that mental health treatment is covered within the scope of today's health insurance plans. There has always been a lingering stigma behind mental health issues, and being able to get the treatment that you need through the use of your health insurance plan is a major step toward the continued fight to combat this stigma.
What is Provided?
As a result of the 2008 Mental Health Parity and Addiction Equity Act, insurance providers that do cover mental health treatment are required to offer coverage in this area that's comparable to the coverage offered for matters of your physical health. This law is in effect over insurance plans such as those that are sponsored by an employer or ones that are purchased through a health insurance exchange. It also pertains to the majority of Medicaid programs and the Children's Health Insurance Program. Though this move is certainly one that goes in the right direction, the law doesn't make it a requirement that insurers provide mental health treatment coverage. Rather, they're simply required to cover this treatment equally in the case that it's covered.
Does Your Insurance Cover Treatment for Mental Health?
As previously mentioned, it's not required under the law that a health insurance provider covers treatment for mental health. Due to this fact, it's up to you as the insured to check your benefits description and find out if your particular plan covers treatment for mental health issues.
Mental health issues affect us all. Virtually all of us have known someone who has suffered from the often debilitating effects of mental health difficulties. Therefore, it's a great step in the right direction that there's now a great deal more parity in the health insurance industry in regard to the coverage of mental health treatment as part of the plans that are available today.
If you want to attract great employees and avoid a high turnaround rate, it's important to offer competitive and comprehensive health benefits to your employees. As an employer, you'll need to decide what health benefits to provide your employees to ensure that they're satisfied and feel compensated for their hard work and dedication to the company. Here are a few health benefits to consider in order to improve retention.
Benefits can be more important than salary for employees. Health insurance is one of the most coveted benefits for employees, and having them also means that your team members won't take as much time off of work due to health concerns. With quality health insurance provided, you can improve the operations in the workplace and help your employees to have less stress due to medical bills or a lack of coverage. Employees may also accept better health insurance instead of a higher salary for added savings for your company. It can also allow you to obtain tax advantages of deducing plan contributions.
Source: Why Benefits Are More Important Than Salary
Employee Wellness Programs
More companies are incorporating employee wellness programs into the workplace as a way to show they care about the health and well-being of the staff as a value on investment. The quit rate from 2018 is nearly at a 17-year high, and those workers are searching for something better. Retention increases when companies demonstrate that they care about healthy employees — and this extends even to workers who don't make use of a wellness program. A survey found that 73% of employees without access to wellness programs want them.
Source: Value On Investment: The Case for Employee Wellness Program Benefits
Dental Care Plan Coverage
Consider offering insurance that will pay off a portion of the cost of dental treatment and care. Dental health coverage often includes different types of procedures and treatments. Most care plans include Preventative, Basic, and Major services to ensure that the individual can maintain their oral health. The benefits can be calculated in multiple ways with coverage provided based on usual, customary, and reasonable fees. It can also be calculated with the inclusions taken into account on a fixed fee schedule or table of allowances. Be sure to let your employees know that in most plans, cosmetic or orthodontic work is not covered in basic plans, and if that is something they need, they may need to do a bit more exploring. For example, while most dental plans will cover fillings, they will only cover amalgam (silver) fillings, while the composite ones would require additional cost.
Source: The 5 Things You Should Know Before You Buy Dental Insurance
By selecting the right health benefits to offer to your employees, you can create a stronger team that is composed of confident professionals. The compensation that is provided will allow more people to remain loyal to the company and can attract better candidates as you grow your team.
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Since the 2019 Open Enrollment Period is over, you can now enroll in or change a Health Insurance Marketplace plan only if you have a life event that qualifies you for a Special Enrollment Period.