A good traditional health plan should allow you to select the plan type, the desired benefit payment structure, and only the options you want.

Look for the following plan types when doing your research:

PPO Copay Plans feature physician and hospital networks. A covered person pays only the selected copay amount for each covered visit to a physician’s office, urgent care center, or non-surgical outpatient facility.

PPO Plans feature physician and hospital networks but do not include an office visit copay. They are generally more economical than PPO Copay Plans.

Hospital-Only PPO Plans offer hospital networks but not physician networks. They are a good choice where there is no local physician network or if the local physician network does not meet your employees’ needs.

Traditional Indemnity Plans are best suited for those who live and work outside a PPO network area. Plans are subject to usual and customary charges.

HSA and HRA Plans are high deductible health plans specially designed to work with recent, federally approved financing programs, known as Health Savings Accounts and Health Reimbursement Arrangements.

The next aspect of plan customization is payment structure. You can control the cost of your insurance premium by selecting the amount of the lifetime maximum benefit, annual deductible, office visit copay, rate of payment, and out-of-pocket limits.

Finally, a comprehensive traditional health plan should offer optional benefits that you can include or not, based on your group’s needs and your need to control your costs. Some of the options to look for are:

·          Outpatient prescription drug coverage — including preferred pricing, brand name purchase options, a mail order service, and non-network purchase options

·          Accident Medical Expense (AME) benefit — 100% first-dollar coverage for treatment of an accidental injury that is received within 90 days of the accident

·          Maternity benefits

·          Waiting period — you choose the amount of time all new employees have to wait before being covered