Employee Medical Benefits


jaymar insurance medical

Health Insurance continues to be the most scrutinized benefit in the country. Employers face a unique set of challenges today as demographics shift and medical costs continue to rise. There are many medical products available to you, each with its own unique characteristics. JayMar Insurance Agency will assist you in determining the plan or plans that best suit your business needs and the needs of your employees.
There are basically four types of Medical plans, HMO’s, EPO’s, POS and PPO plans. Dual Choice plans and CDHP’s use these plans as a foundation for their program.

Health Maintenance Organizations (HMO’s)


HMO’s are networks of medical care providers that consist of primary care providers, (PCP’s), specialists, hospitals and ancillary providers. Coverage is only available when using the in-network providers, except in an emergency. It is usually the least expensive approach as the patient has the lowest level of freedom with provider care selection.

    1. The plans emphasize preventive care through annual physicals, usually at no cost
    2. Payment is typically structured using co-pays for office visits or other facilities such as hospital emergency room, hospital in patient stays, radiology procedures
    3. The PCP coordinates the treatment and authorizes access to specialists, surgery, hospital stays and medical tests through their referrals

Exclusive Provider Organizations (EPO’s)

EPO’s are an excellent alternative to the lower cost HMO plans if the insured does not want referrals as a part of their plan.
    1. EPO’s provide in-network coverage only except if it’s an emergency
    2. There are no referrals needed when seeing specialists (no gatekeeper)
    3. With EPO’s, providers are only paid for services provided while under HMO’s, the provider gets paid a fixed monthly fee from carriers.



Point of Service (POS)

POS plans include an HMO element for the in-network benefits and also provides out-of-network coverage.

    1. In-network coverage is structured like an HMO with co-pays for each benefit area
    2. Non-network coverage is provided with lessor benefits and are subject to deductible and coinsurance.
    3. Maximum out-of-pocket feature built into the non-network coverage limits the patient’s expenses at a pre-set limit
    4. The cost for POS plans is higher than HMO and lower than PPO plans.


Preferred Provider Organization (PPO)

PPO plans include coverage for in and out-of-network services and no referrals are needed.

    1. The PPO networks are generally larger than HMO networks
    2. In network services are usually subject to deductibles and/or coinsurance cost sharing features
    3. Out-of-network services are usually subject to higher deductibles and lower coinsurance reimbursement levels
    4. PPO networks can be national in scope


Dual Choice Plans

Dual Choice plans are used to best meet the needs of all employees and provide an excellent overall approach to reducing health care costs compared to PPO plans. Employees have a choice at the beginning of each plan year as to which plan they want for the upcoming year, the HMO or PPO.


    1. Younger and healthier employees may prefer an HMO plan as it emphasizes preventive care and it costs much less than PPO or POS plans
    2. It gives employees who are willing to contribute higher payroll deductions the freedom of choosing a plan with non-network coverage (PPO plan)
    3. Employee contributions can be set to steer employees to the lower cost HMO or EPO plans



Consumer Driven Health Plans (CDHP)

CDHP’s are designed to engage employees to better understand and manage their own health expenses

    1. CDHP’s involve a high deductible plan and a tax-exempt health account, usually an Health Savings Account (HSA), Health Reimbursement Account (HRA) and/or a Flexible Spending Account (FSA).
    2. Employees use the account to help cover deductibles, coinsurance and qualified health care expenses as well as to help save for future health care expense


JayMar Insurance Agency Helps You Choose the Right Plan

The most important goal we want to achieve is to provide you with the best coverage for yourself, your employees and their families at the lowest possible cost. We will review the demographics of your employees, specifically their zip code location to make sure that the network (or networks) under the Medical plan (or plans) being considered, will give each person the maximum coverage available. In certain circumstances, a dual option plan could be the most effective program for your company as it offers each employee a low cost alternative  (HMO or HSA plan) along with a higher cost alternative (POS or PPO) that could be subject to employee contributions through payroll deductions.


JayMar Insurance Agency will work closely with you to help manage the process of choosing the right plan through the implementation and communication processes.