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Your Health Care

Working with Human Resources for Better Health Care

June 14, 2018
Pick Your Plan

A recent Kaiser Family Foundation survey found most companies offering health benefits offer only one type of health plan. Here are some things to know about the most popular types:

  • Preferred Provider Organization (PPO) plan. Most employers offer this plan, in which you see any provider who's a member of your insurance plan's network. You can usually see specialists without a referral.
  • Health Maintenance Organization (HMO) plan: This plan offers a wide network of health care providers, with care coordinated by your primary care provider (PCP). Usually, specialist visits require a referral from your PCP.
  • Exclusive Provider Organization (EPO) plan: Utilize all the providers within your network plan, and that means specialists, too. But don't expect any coverage outside your network.
  • High-Deductible Health Plan (HDHP): Just like it sounds, you'll meet that high deductible before coverage kicks in. If you want low monthly premiums and don't expect to use lots of coverage, this may be for you. An HDHP is usually connected to one of the other types of plans listed above, but typically they are PPO’s.
Use Human Resources … As a Resource

Before you choose a plan, ask your HR representative to help answer specific questions about:

  • Exactly what is covered and who is covered.
  • Status of coverage for working spouses or dependent children.
  • Best ways to save on your health care costs.
  • Different types based upon your personal circumstances.
  • What preventive care is covered.
  • The benefits of using doctors in your plan —or not—and what that means to you.
  • Tax-deferred health care expense accounts such as Health Savings Accounts (HSAs).
  • Whether you can make changes once you're enrolled, especially if you have a qualifying life event that may happen outside of open enrollment—like getting married or having a baby.
  • Advice on emergency, urgent, maternity and chronic condition care.

How prescription drug coverage works - your plan may offer three tiers, including:

  • Generic: Less expensive copies of brand-name drugs.
  • Formulary brand: On a preferred drug list.
  • Non-formulary brand: Not as cost-effective, with generic equivalents in the marketplace.
  • Whether you’ll have access to telemedicine or remote clinical services can save you money.

Many employers offer info sessions about the upcoming open enrollment period so take advantage of them. They're a resource, so ask HR for help if you need it. Together, you'll take better care of you.