Tabla De Comparación Del Plan De Salud

A continuación, se detalla un desglose de lo que generalmente presentan varios tipos de planes. A medida que lea sobre cada tipo de plan, recuerde que el mercado actual de cobertura de salud habitualmente ofrece "mezclas" de estos tipos tradicionales. *Las primas mensuales representan el costo total para un solo empleado (aportes del empleador y del empleado). Si comparte los costos de las primas con el empleado, sus costos comerciales serán menores. Los rangos de precios reflejan los promedios nacionales para 2018; Las primas para su negocio pueden variar según su ubicación, la edad de los empleados y otros factores.

Plan Types What is covered? Whom can you see? Cost-sharing at time of service Monthly premium* Summary
HSA

Comprehensive up to savings account limit, and usually comprehensive above deductible. Employee responsible for share of deductible after savings account funds are spent.

Below deductible: any doctor. Above deductible: benefits generally reduced for services outside the network.

Employee pays with spending account funds, and then out-of-pocket, up to a high deductible (for example, $4,000). Copayments and/or co-insurance apply after deductible.

Usually a low-cost option (monthly premiums for high-deductible plans average $550). Policies with higher deductibles typically have lower premiums.

Good option if employers and employees share an interest in keeping monthly premiums low. Employer must be willing to set up and administer savings accounts; insurance carriers, financial institutions, brokers and other advisers can help. HSAs may be less attractive to older and sicker employees, whose health needs may use up their savings account and require additional out-of-pocket payments.
POS

Usually comprehensive

Any doctor referred by primary care physician; benefits reduced for services outside the network if not referred by PCP.

Contact a broker for detailed information on costs.

Contact a broker for premium quotes, but the national average is roughly $600/month. 

Offers more flexibility than HMOs but less than PPOs. Employees should be willing to assume responsibility for some administrative duties (such as obtaining referrals or submitting claims).
PPO

Usually comprehensive

Any doctor, but benefits reduced for services outside the network.

Typically have copayments between $10 and $50, co-insurance up to a deductible.

Depends on cost-sharing: High deductibles usually mean lower premiums and low deductibles mean higher monthly premiums. The national montly average is roughly $600. 

Good option if choice of providers is important to employees. Employees should be willing to assume responsibility for some administrative duties (such as obtaining referrals or submitting claims).
HMO

Usually comprehensive.

Limited network; no benefits for services outside network. Generally, services must be referred by primary care physician (some exceptions such as preventive gynecological exams, emergency services, etc.).

Typically low copayments at time of service ($10 to $40); no co-insurance.

Typically medium range; averages roughly $575.

Makes sense when employees are willing to give up flexibility in provider choice and accept greater management of their care. Also offers benefits in terms of ease of administration. Less attractive if some or many employees feel strongly about having access to a wide selection of providers.