Understanding Our Plans

We know employees get sick or hurt, and when they do, they need health care. They can’t always avoid the bad stuff life throws at them, but it’s nice to help them through it. That’s why we’re here–to give them insurance for real life.  We explain more about our plan options below.

HMO (Health Maintenance Organization)

  • Only HMO participating care is covered, but at very affordable rates.
  • Non-participating care is covered in emergencies or when referral preauthorizations are given.
  • Members choose primary care providers (PCP) to coordinate all their medical care.
  • Women can also choose Woman’s Principal Healthcare Providers (specializing in obstetrics, gynecology, or family practice) in addition to their PCPs.

PCPs understand the big picture of members' health and serve as a healthcare partner. Ask your client consultant for more information on our extended network options for employer groups.

PPO (Preferred Provider Organization)

  • PPO members can see any provider, but they’ll get the greatest out-of-pocket savings when staying in the Participating network. Members are not required to select a primary care provider (PCP) to coordinate care.
  • We do not require PPO members to get a referral for specialty care, although some provider practices may require it.

We have a strong network of top-notch doctors, hospitals, clinics, and pharmacies. Ask your client consultant for more information on our extended network options for employer groups.

POS (Point of Service)

  • Coverage is determined at the point of service,dependent on the provider chosen. When choosing one of our network providers, HMO-style benefits apply. When choosing a non-participating provider, indemnity benefits apply (except in emergencies, as defined by law).
  • Women can also choose Woman’s Principal Healthcare Providers (specializing in obstetrics, gynecology, or family practice) in addition to their PCPs.

POS plans are a combination of HMO financial advantages with non-participating provider benefits at a limited (indemnity) coverage level. Members have the freedom to go out-of-network, but can save money when staying in-network. Our network is extensive and features premier providers. PCPs understand the big picture of members' health and serve as a healthcare partner. Ask your client consultant for more information on our extended network options for employers.