Group Health Plan Types

Group health plan types are the different ways a health plan can be built: how big the doctor network is, whether employees need a referral to see a specialist, and how the premium trades off against out-of-pocket cost. Group health insurance itself is coverage that an employer sets up for its workers, rated as a group rather than person by person, with the business and employees usually splitting the premium. Once you know your group is buying coverage, the next decision is which plan design to buy it in, and that is what this page walks through.

Group Health Kansas is an independent broker. We do not sell one carrier's plans. We shop the Kansas market across plan types and carriers, so you can compare a PPO against an HMO against a high-deductible plan with real numbers for your team, not a sales pitch for one option.

Every plan type below answers the same three questions differently: how wide is the network of doctors and hospitals, does an employee need a referral before seeing a specialist, and how much does the plan cost each month versus at the time of a visit. Once you know how your team answers those questions for itself, the right plan type usually becomes obvious. The sections below walk through each plan type in order, from the widest and most expensive network to the narrowest and least expensive, so you can see the tradeoff as you go.

PPO plans

A PPO, or preferred provider organization, gives employees the widest choice of doctors and hospitals. They can see any provider, in network or out, without picking a main care doctor or getting a referral to see a specialist. Staying in network keeps costs lower, but the plan still pays something if an employee goes outside it. That flexibility comes at a price: PPO premiums usually run higher than HMO or EPO plans with a similar deductible. A PPO suits a team that travels, has family spread across different cities, or simply wants the freedom to see any specialist without asking permission first.

Think about an employee whose child sees a specialist two states away, or a remote worker who splits time between Kansas and another state. A PPO keeps that kind of care covered without extra approval steps, which is exactly the situation where the higher premium tends to pay off.

HMO plans

An HMO, or health maintenance organization, keeps the premium lower by using a defined network and asking each employee to choose a main care doctor. That doctor coordinates care and generally has to refer the employee to a specialist before the plan will cover the visit. Care outside the network is usually not covered except in an emergency. An HMO suits a team that is comfortable working within a set network of local doctors and wants a lower monthly premium in exchange.

For a team clustered in one Kansas metro area, say Wichita or Overland Park, a strong local HMO network can cover almost everything an employee needs day to day, so the referral step ends up being a minor inconvenience next to the savings on premium.

EPO plans

An EPO, or exclusive provider organization, sits between a PPO and an HMO. Like an HMO, it only covers care inside its network, and going outside the network typically means paying the full cost yourself. Unlike an HMO, most EPO plans skip the referral requirement, so employees can go straight to an in-network specialist without a referral from a main care doctor. An EPO suits a team in an area with a strong network of in-network specialists, where members want a lower premium than a PPO without the referral step of an HMO.

An EPO tends to fit a team that already knows and likes the doctors in a given network and does not mind staying inside it, but does not want to deal with a referral every time someone needs to see a specialist.

POS plans

A POS, or point-of-service plan, mixes HMO and PPO features. Employees pick a main care doctor and generally need a referral for specialist care, similar to an HMO, but the plan also pays a share of out-of-network care, similar to a PPO, usually at a higher out-of-pocket cost. The premium tends to land between a PPO and an HMO. A POS plan suits a team that wants the lower cost and coordinated care of an HMO but likes having the option to go outside the network occasionally, say for a specialist a main care doctor recommends who happens to sit outside the plan's network.

High-deductible health plan with an HSA

A high-deductible health plan pairs a lower monthly premium with a higher deductible, meaning employees pay more out of pocket before the plan starts covering most costs. When the plan qualifies under IRS rules, employees can pair it with a health savings account, or HSA, a tax-advantaged account that both the employer and employee can contribute to. Funds in an HSA roll over every year and go with the employee if they leave your company, unlike a use-it-or-lose-it account. The IRS sets the contribution limits and the rules for what counts as a qualifying high-deductible plan at irs.gov. This design suits a team with mostly healthy, lower-utilization employees who would rather keep the premium down and build savings for the years they need more care.

Some employers also contribute directly to each employee's HSA as part of the benefit, which softens the higher deductible and gives the plan design broader appeal across a team with a mix of ages and health needs. Whether that makes sense for your budget is something we can work through together when we shop your plan.

How to choose a plan for your team

Start with how your team actually uses care. A younger group with few ongoing prescriptions or specialist visits often does well on a high-deductible plan with an HSA. A team with employees managing chronic conditions or frequent specialist visits may value the wider access of a PPO, even at a higher premium. Ask how your employees feel about network restrictions and referrals, since an HMO or EPO can save real money but only works if the local network covers where your team actually goes for care. Many Kansas employers offer more than one plan type side by side, so employees can pick what fits their own household. You can read the federal marketplace's overview of plan types at healthcare.gov, then let us shop actual Kansas carrier quotes across the designs that make sense for your group.

How you can fund the plan

Plan type is one decision. How your business pays for the plan is a separate one. Most small Kansas groups buy a fully insured plan, where the business pays a set monthly premium to the carrier and the carrier takes on the risk of claims. Some larger or more established groups use level funding instead, where the employer pays a set monthly amount that covers expected claims, administration, and stop-loss protection against an unusually costly year, with the possibility of a refund if claims run low. Level funding can be paired with a PPO, HMO, EPO, POS, or high-deductible design. Neither approach is automatically cheaper. The right choice depends on your group's size, claims history, and appetite for risk, which is part of what we review when we shop your renewal.

Ready to see real numbers instead of guessing between plan types? Request a free quote and tell us how your team uses care, and we will shop Kansas carriers across the plan types that fit. Or call 913-336-5041 and talk it through directly.

Where to go next

If you are just getting started, see our overview of small business health insurance for teams of 2 to 50, or large group health insurance if your headcount is past 50. Once you have a plan type in mind, our guide to small business health insurance cost walks through what actually moves your premium. Whenever you are ready, get a free quote and we will bring you real plan options instead of a single carrier's shelf.