Employees value health care coverage perhaps more than any other benefit,
but employers are struggling with the escalating costs of providing quality programs.
PAA offers a number of insurance carriers in all areas of Pennsylvania with a wide
range of benefit choices. These choices will enable employers to design benefit
packages that meet their needs and fit their budget.
Health care plan options differ regionally across the state, and not all program types listed below may be available in your geographic area, but all areas offer a variety of carriers and benefit options.
PPO (Preferred Provider Organization Programs)
These plans are designed for groups who want the greatest flexibility within a network program. Subscribers are free to see any health care provider within the network and receive the highest level of benefits or choose to see providers outside the network for a lower level of coverage. There is no need to select a primary care physician or get referrals for specialty care.
POS (Point of Service Programs)
Subscribers choose a primary care physician from an extensive network and get referrals for specialty care for the highest level of benefits. Members also have the option to use out of network providers at a reduced level of benefits.
HMO (Health Maintenance Organizations)
These plans generally offer subscribers lower out-of-pocket expenses with a network of healthcare providers specifically credentialed by the carrier to ensure quality care. Members choose a primary care physician who provides or coordinates the individual's health care needs. Most services must be performed or authorized by the primary care physician in order to be considered a covered service.
HDHP (High Deductible Health Plan) with HSA (Health Savings Account)
HSAs coupled with a qualified HDHP are becoming increasingly popular. HDHPs have higher deductibles and more out of pocket costs than other health care plans but can help the members take control of their health care expenses by offering catastrophic medical coverage at a lower premium. Once enrolled, account contributions can be made by an employee and/or employer to a tax-advantaged health savings account (HSA). The HSA can be used to pay for qualified health expenses tax free; the member owns the HSA and chooses how and when to use the funds.
HRAs (Health Reimbursment Accounts)
HRAs are employer established benefit plans which combine the protection of a deductible-based health plan with a health fund that pays for eligible services. Employers have control over HRA plan designs; employees cannot contribute to the HRA. Employers may choose higher deductible health plans at lower premiums and fund some of the deductible through an HRA account. This design can save premium dollars while still protecting employees from catastrophic out of pocket expenses.
This link leads to the machine-readable files that are made available in response to the federal Transparency in Coverage Rule and includes negotiated service rates and out-of-network allowed amounts between health plans and healthcare providers. The machine-readable files are formatted to allow researchers, regulators, and application developers to access and analyze data more easily.