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What You Need to Know: Health Plan Types

This article is part of a series on what you should look for in your health plan.

GDA_20160629_Biddy-01-EditAt medical plan renewal time, the Georgia Dental Association office is always flooded with calls from members asking about how to choose a health plan that is right for them. While premium cost is always of concern, more and more dentists, spouses, and staff members want to share their medical insurance horror stories and ask if their dental association can help them find a better option. That is my favorite part—when I and the rest of the GDA health plan team can talk to members about the competitive, comprehensive health plans the GDA has for dentists, dental families, and dental team members.

Since we are about to enter the medical plan renewal season once again, your GDA health plan team wants to share some basic tips about choosing a health plan. We also want to share that you can choose a GDA group health plan starting November 1! We are excited about the options we will be able to offer our members. Call your GDA health plan team at 800.432.4357 for information, or visit us online at www.gadental.org/health to see our complete plan information and sign up for a webinar on November 4.


Health Insurance In the News

1.4 million people in 32 states will lose the Affordable Care Act plan they have now, according to state officials contacted by Bloomberg. 


What You Need to Know: Plan Types

There are three main types of health plans that you will see offered as you visit the health care exchanges or research health coverage at all. These are Health Maintenance Organizations (HMOs), Preferred Provider Organizations (PPOs), and Point-of-Service Plans (POS). Each of these coverages has their advantages and disadvantages.

HMO

HMOs deliver all health services through a network of health care providers and facilities. Most HMOs will require a referral from a primary care physician before you can see a specialist. A participant must select their primary care physician from the HMO network. You may have the least freedom to choose your health care providers with an HMO—if you see a doctor who is not in the network, you’ll likely have to pay the full bill yourself. 

PPO


PPOs may offer moderately more freedom to choose your health care providers than an HMO. You typically do not need to obtain a referral from a primary care doctor to see a specialist. There will be higher out-of-pocket costs if you see out-of-network doctors, but you may not be footing the entire bill yourself. PPO coverage usually requires payment of an annual deductible. Once your expenses exceed the amount of this deductible, insurance coverage kicks in. The deductible amount is in addition to any co-payment. 

POS


A POS plan combines features of an HMO, a PPO, and “traditional” health insurance. Like an HMO plan, you may be required to designate a primary care physician who will then make specialist referrals. Like a PPO plan, you may receive care from non-network providers but with greater out-of-pocket costs. You may also be responsible for co-payments, co-insurance, and an annual deductible. You may see the phrase “open access” attached to a plan. This means that plan members have choices in what doctors to see and services to use. For example, members may be able to choose specialists without a referral from their primary care doctor. However, the choice must be made from an approved directory of specialists or the member pays more of the associated cost.

DID YOU KNOW?

The GDA group health plan currently offers all open access point-of-service plans, offering maximum flexibility in choosing the doctors you want and need.

Christy Biddy is your Medical Benefits Coordinator, and can be reached at christy@gadental.org or 404.636.7553 x113.

Open Enrollment 2016 Health Plans
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