Group Health insurance plans are those provided through an employer to cover its employees. These are commonly from Health Management Organizations (HMOs) or Preferred-Provider Organizations (PPOs). Depending on your plan, you may be restricted only to see healthcare providers in the plan’s network. Some plans require you to have a primary care physician and to get referrals before seeing a specialist.
What are the Costs?
If your plan has a network, it will cost more to see healthcare providers that are not in your network. You may have to pay the full amount for those services. Each plan will assign you copayments for each visit, monthly premiums, and a yearly out-of-pocket deductible. Copayments would be a flat rate assigned to doctor’s visits and a higher rate for emergency room visits. After you reach the plan’s maximum for out-of-pocket costs, the plan will pay 100% for covered services.
What are the Plan’s Benefits?
Group health plans offer a standard amount of coverage for hospital and medical expenses. Most plans have prescription drug coverage, and many have dental, vision, and hearing options available. The healthcare providers you see may be effectively limited by a plan’s network as the costs of out-of-network doctors is prohibitive. You should always be covered in the case of an emergency. In most cases, out-of-state dialysis treatments and medical emergencies will be covered as well.
Contact Our Experts At Generations Insurance
Navigating the options for group health insurance plans can be challenging. Contact the experts at Generations Insurance for guidance in your search or with any questions.