HMO, PPO, POS: What plans should you offer?
When thinking about employee benefits, one of the most important things to consider is which health plans you’ll offer. All Wellmark health plans provide access to the Wellmark provider network, and you can choose to offer one or several plan options based on the needs of your employees.
Generally, the differences between plans include the number of health care providers covered under the plan, how much your employees will pay for care out-of-pocket and the availability of out-of-network benefits.
Understanding the basic types of health plans and how they leverage the Wellmark provider network will help you guide employees toward high-quality care at the lowest possible cost to achieve better overall health — which saves them (and you) money in the long-run.
Find the right plan for your employees
Whether you have one employee or 50, we’ll help you decide which plans work best for your small business. Start here to find the plans that fit your budget and your business.
Explore Wellmark HMO, POS and PPO plan options
HMO plans (state-based)
Health maintenance organization — or HMO — health plans give your employees access to providers and hospitals in a specific area and only cover out-of-network care in emergencies. Your employees may need to choose a primary care provider to help manage their care. They’ll also receive no-cost preventive care from this provider.
Because HMOs are more local, they improve care coordination. They're also less expensive for you and your employees because they typically only offer coverage for care from in-network providers in a single service area. An HMO plan is ideal if your employees work and live in a single state.
Wellmark Blue HMOSM plans are only available in Iowa.
POS plans (in- and out-of-state)
Point-of-service (POS) plans are similar to HMOs, but provide a cost share option if your employees want access to national benefits. POS plans offer flexibility for your employees by providing in-network coverage from local doctors and hospitals, while allowing out-of-network coverage from participating doctors at a higher cost share.
Keep in mind that for any out-of-network services, your employees will have to do some of the legwork like filling out paperwork, sending bills for provider payment and keeping track of service receipts. A POS plan is a moderately priced option for your business, as most care is provided within the network and any out-of-network care comes with higher out-of-pocket costs for your employees.
A POS plan may be right for your employees if they live in one area but may need the flexibility of seeing out-of-network care. Wellmark Blue POSSM plans are only available in Iowa.
PPO plans (national)
A preferred provider organization (PPO) plan offers the most flexibility for your employees. They will be able to go to any in-network doctor or hospital nationwide. Costs will be lower for in-network services, but PPO plans also pay a portion of out-of-network costs. Compared to other options, PPO plans are the most expensive. But, if your employees live, work or spend long periods out-of-state, and are more likely to need medical care when they’re traveling, a PPO plan may be the best fit.
Wellmark Blue PPOSM plans are available in Iowa and South Dakota.
Find the right balance of coverage, cost and flexibility
With the largest network and some of the best benefit options, you have options with Wellmark. Learn more about our network and start comparing plans.