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If you are reading this article, more than likely, completing the MsFiscallyFit Benefits Checklist (click here for checklist) was an eye-opening experience. In most cases you discovered that your company offered more benefits than you thought. This is a good thing! But what the heck is a FSA or a PPO? The key to maximizing your return on employee benefits is to know exactly what your company offers and how it can benefit you and your family.
In this series, I will go over the specifics of several of the most common employee benefits and how you can use them indirectly or directly to save or make more money. Take your completed MsFiscallyFit Benefits Checklist and find the ones that apply to you. If you have any benefits that are offered by your company, but never get addressed in this series, please feel free to e-mail me the name or type of benefit and I will research it for you.
(e-mail: infomaster@msfiscallyfit.com)
Medical Coverage Through Managed-Care
Because of the rising costs of healthcare, many companies offer a managed care program, the most common is the health maintenance organization ("HMO"). The benefits of an HMO are they typically carry no deductible and the patient's copayment is very low. On the otherside, HMOs limit your access to specific medical providers and are best for individuals and families with average needs like routine, periodic checkups or curing the common cold. But if you or any of your family members need a certain medical specialist and they are not one of the pre-approved physicians in the network, you will receive no or a limited reimbursement for the medical costs. Another downfall to HMOs are the extra layer of paperwork and processing required to even receive any specialized medical care. With an HMO, all your ailments must first be examined by a primary-care physician, a general practitioner, and only they can give you a referral to a specialist doctor. Of course, not until you have waited through a sometimes long approval process. Your primary-care physician becomes your "gatekeeper" for all your medical needs.
If you are looking to cut medical costs an HMO is a good way to go. But make sure you choose a very good primary-care physician, because they are your doorway to good medical care. If you can't find your regular doctor in the HMO network, ask for referrals from friends and coworkers. I was told by a woman who provides all types of medical insurance to large companies to always select a physician that is connected to a very good and well-known hospital near your home or office. This way if you or any of your family members require specialized medical care, your primary-care physician will have a great pool of other doctors to choose from and the hospital facilities and auxiliary medical services will be top-notch.
If you are looking for more flexibility in choosing your doctors and don't mind the extra costs, go with a preferred-provider organization ("PPO"). Through PPOs, you can see doctors that are not part of the network, but the reimbursement level will be much lower, sometimes as low as 50%. In general, PPOs like its managed-care sister the HMO, does not charge deductibles and will cover you on routine, preventive care exams.
Although nobody likes to read all the fine print in the HMO or PPO brochures, I discovered you could be losing money if you don't know exactly what you are required to pay for and what you aren't. For example, many HMOs and PPOs provide the routine annual women's wellness exam (Pap's) for free and do not require you to pay an office visit copayment. But the doctor's office can not possibly know all the managed-care plans out there so they are trained to always ask for a copayment. Make sure you are very clear on what your plan provides and don't be afraid to say, "My plan provides this service for free. Please call this number if you have any question." Don't let the doctor's office intimidate you into paying extra money you don't need to. This is a very common error.
A final tip: Always carry your medical ID card with you. Because if you have an emergency without the card you may be required to pay all the medical charges on the spot, in full.
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