Medical Benefits

Carol CA

I am in California and we currently offer two medical plans -- an HMO with a twist where you can go to doctors in other networks than your primary care physician for a higher co-pay, and a Point of Service (POS) Plan. We have 135 employees and only 5 employees are enrolled in the POS plan. We are coming up for renewal January 1 and are seeing very high increases in the premiums, especially the POS plan. Due to the higher costs and low participation rate, is it OK to only offer the one HMO plan and drop the POS plan? I thought I had heard somewhere that in the state of California you could not restrict your employees to only an HMO plan. Even though ours has the option to go to other networks for consultation, your treatment must still be in your network, so it's still an HMO. What do you think?

Thanks!

dhnyct

Over half of our employees choose POS over HMO because of the flexibility of providers, etc. The POS rates are higher, but not to an extreme. How long has it been since you shopped for a different carrier? Can't comment on CA regs, but I'd tried to maintain coverage options.

TBHRPRO

In the state of Tennesse, you must offer an alternative to the HMO. I don't know if this is state specific. We changed last year to a HMO/POS from a HMO/PPO plan.