Network type is a renewal decision, not just a plan label.
HMO, PPO, EPO and POS describe how employees reach providers. At renewal, the network type decides which doctors stay in reach, what referrals are required and whether a carrier change disrupts care. Here is how we work through it with Michigan employers.
Five network questions to answer before you renew
Provider Disruption Analysis
Match your employees’ current doctors and hospitals against a new network before you move carriers.
Referral and Out-of-Network Rules
HMOs generally require referrals and cover little out of network. PPOs and EPOs differ on both points.
Multi-State and Remote Workforce
Employees outside Michigan may sit outside a regional network, which can narrow the choices.
Offering Two Plans
Offering a lower-cost network plan alongside a broader one can give employees a choice and manage cost.
HSA Eligibility Follows the Deductible
HSA eligibility depends on a qualifying high-deductible plan, not on whether the network is HMO, PPO or EPO.
Minimum Value Is Not a Network Question
ACA minimum value is tested on plan design and cost sharing, not on the network type.
How the four network types differ
HMO
Care is generally in network only, with a primary care physician and referrals to specialists.
PPO
Employees may see in-network or out-of-network providers, with higher cost sharing out of network.
EPO
In-network only, like an HMO, but usually without the referral requirement.
POS
A hybrid. Primary care coordinates referrals, with some out-of-network coverage at higher cost.
Michigan carrier guides
Network type is set by the carrier’s plan design. These guides set out what each carrier says about its employer plans and the questions we ask before a renewal.
Blue Cross Blue Shield of Michigan
PPO, POS and HMO plan families and the claims to test.
Blue Care Network
How an HMO changes referrals and disruption.
Health Alliance Plan (HAP)
Henry Ford Health Select and the plans being phased out.
Priority Health
Regional, tiered and narrow network solutions.
BCBSM vs. HAP vs. Priority Health
How the three carriers describe their employer plans side by side, and the questions we ask before comparing them for a renewal.
Network type questions from Michigan employers
What is the difference between an HMO, PPO and EPO?
An HMO generally requires in-network care and referrals. A PPO covers out-of-network care at higher cost. An EPO is in-network only but usually does not need referrals.
Which network type is cheapest for an employer?
Narrower networks tend to carry lower premiums, but the right answer depends on your employees’ providers and how much disruption you can accept.
Does network type affect HSA eligibility?
No. HSA eligibility depends on enrolling in a qualifying high-deductible health plan. Any network type can be paired with one if the plan design qualifies.
Should we offer more than one network type?
Many employers offer two plans so employees can choose between a broader network and a lower-cost option. We review the tradeoffs at renewal.
How do we check whether our employees’ doctors stay in network?
Request the carrier’s provider directory data and compare it with where your employees receive care. We build that comparison into a renewal review.
What should we send for a renewal review?
Send the renewal, the current plan summary, the census and recent claims reports if available. You can send them through our renewal page.
Ready? Send us your renewal, or talk it through with someone first. General information, not legal or tax advice.
Where these details come from.
HealthCare.gov: Health insurance plan types: Plain-language comparison of HMO, PPO, EPO and POS.
IRS Publication 969: HSA and high-deductible health plan rules.
CMS: Minimum value: Minimum value and affordability guidance.
Send us your renewal.
We’ll tell you whether it looks competitive, where we see opportunity, and the five questions we’d put to your carrier. No cost, and no obligation to move anything.
The renewal letter
Your current plan summary
Contribution split by tier
Enrolled counts by tier
Four documents — two more if your group is 50 or more. Nothing else; every extra one is a reason to postpone.
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