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Tolbert & Associates utilizes a consultative approach to helping clients research and choose a group medical insurance plan. We utilize our experience and knowledge of carrier plans to design and present unique plan solutions to meet your company's needs.


There are numerous plan types to give you flexibility in determining the right group medical plan for your company and its employees.


HMO: Health Maintenance Organization

Health Maintenance Organizations (HMO) utilize a defined network of physicians and hospitals. In a traditional HMO members must select a primary care physician (PCP) to coordinate their health care needs. If a member needs services of a specialist they must be referred by their primary care physician and the specialist must also be in the HMO network. All benefits must be provided by in-network providers; there are no out-of-network benefits payable. Open Access HMO's all members to forgo the PCP requirement but must use in network facilities and physicians for benefits to be payable. This enables members to keep premiums low and out-of-pocket expenses to a minimum.


High Deductible Health Plans

High Deductible Health Plans offer members much lower average premiums in exchange for accepting a high annual deductible. All covered medical benefits, except preventative care, apply toward the annual deductible. There are no physician's office co-pays and no prescription co-pays. Typically, a High Deductible Health Plan (HDHP) is paired with a Health Savings Account (HSA) enabling members to deposit money into an account to pay for current and future health care expenses. The annual limits for the minimum annual deductible and the maximum annual out-of-pocket expense are set by the federal government.


Indemnity Plans

Indemnity health plans differ from PPO, HMO, and POS plans by allowing you to choose any physician and hospital for services. This gives the member the most flexibility in choosing health care providers but Indemnity Plans are typically more expensive that other type plans.


Open Access

Open Access plans do not require members to select a primary care physician (PCP) or obtain referrals from them in order to access a specialist. However, the specialist does need to be in the plan network in order for benefits to cover treatment.


POS: Point of Service

Point-of Service (POS) plans combine elements of both HMO and PPO plans allowing members to receive care from both in-network and out-of-network providers. In-network medical care is provided by a large network of private practice physicians and hospitals. Out-of-network benefits provide coverage for any physician or hospital selected by the member but at a reduced co-insurance percentage versus in-network care. Members are required to select a primary care physician in a traditional POS to coordinate their health care needs and make referrals to network specialists when needed. The Open Access Point-of-Service plans forgo the primary care physician to combine the security and advantages of an HMO, with the flexibility of traditional indemnity medical coverage.


PPO: Preferred Provider Organization

A Preferred Provider Organization (PPO) allows members to utilize whatever in-network physician or provider they wish without requiring a referral from a primary care physician. PPO's typically offer extensive networks of physicians and hospitals which provide care at negotiated rates. PPO's also provide coverage for out-of-network services but usually at a reduced level of benefit. This type plan offers employers the potential for lower monthly health benefit costs, and employees lower out-of-pocket costs by using the network of hospitals and physicians.


Tolbert & Associates has the experience and expertise to find the right group health plan for your company. Please contact us today for more information.