Health plan terms can be confusing, especially when they're acronyms. This short video explains the basics of an HMO, PPO, EPO, HSA and HRA. (Video, 3:28)Open video transcript
Plans and networks
Learn more about the options available for your large business
Group health plans shouldn’t be one-size-fits-all. We’ll work with you to customize a plan that meets the needs of your employees and your business. Your options are limitless.
Consumer driven health plans
Consumer Driven Health Plans give you economic buying and decision-making power. These plans encourage members to use their health care benefits wisely, while giving them the freedom to decide where to allocate their dollars.
We are sensitive to your business’s needs and the health care needs of your employees. We consider industry, location and business culture to deliver the best CDHP options, products and services.
(Health Savings Account)
(Health Reimbursement Account)
(Flexible Spending Account)
|Overview||Tax exempt account created to pay for the qualified medical expenses of the employee and their covered dependents||An employer-funded account used to reimburse employees for qualified medical expenses||An employer-established, tax advantaged account funded by the employee to pay for qualified medical expenses with pre-tax dollars|
|Business size minimum||2 employees||1 employee||1 employee|
|Who opens the account?||Employee or employer||Employer||Employer|
|Covered expenses||All qualified medical expenses*||Defined by employer||All qualified medical expenses*|
|Who can contribute||Employee or employer or any third party||Employer||Employee|
|Maximum contributions||$3,350 single
|Defined by employer||Defined by employer|
|Rollover of unused balance||Yes||Yes
Defined by employer
|No, funds revert to the employer|
Employers can deposit pre-tax dollars
Employee contributions made through pre-tax payroll deductions
Defined by employer
|Account can be used for retirement income||Yes**||–||–|
*All qualified medical expenses as defined in Section 213(d) of the Internal Revenue Code.
**After age 65, employees may withdraw funds for any reason with no penalty. Although if not used for qualified medical expenses, withdrawals will be taxed as income.
Custom vision coverage
All of our health plans include an annual eye exam at no additional cost from our network of eye care professionals.
Businesses with 51 or more eligible employees have an option to purchase a separate rider for designated collection eyeglasses, frames and contacts. The rider includes coverage for either glass or plastic lenses that meet the standards of the American National Standards Institute.
Contacts can be covered instead of eyeglasses. Eyeglasses or contacts are covered once during a consecutive 12-month period.
Our HMO, PPO and EPO plans
It’s important to understand the difference between the types of plans and what benefits each offer.
- HMO: Coordinated care through a primary care physician
- EPO: Flexibility to seek services throughout Michigan
- PPO: Flexibility to seek services throughout Michigan as well as national coverage
HAP HMO, PPO and EPO plans HMO PPO EPO Primary care physician required? Yes – – Referrals required? Yes
On select services
– – Emergency and urgent care coverage Yes
Out of network coverage – Yes – HMO Choice Plans available? Yes* Consumer driven health plans available? Yes Yes Yes Purchase from HAP | Michigan's Insurance Marketplace | iSelect HAP | Michigan's Insurance Marketplace | iSelect HAP | iSelect
*There are HMO and HMO-HSA Choice plans available to businesses in Genesee, Wayne, Oakland, and Macomb counties. Excluding the following zip codes in Oakland County: 48346, 48348, 48350, 48353, 48356, 48357, 48359, 48360, 48362, 48367, 48370, 48371, 48428, 48430, 48439, 48442, 48455, 48462.
Our HMO network
Our HMO service area includes 19 Michigan counties:
- St. Clair
If you need emergency or urgent care while traveling outside of our service area, don’t worry! You’re covered anywhere in the world.
Our PPO/EPO network
We provide PPO and EPO plans in 26 Michigan counties:
- St. Clair
We provide in-network options across the state to PPO and EPO members. Additionally, PPO members have access to CIGNA or other affiliated national networks when traveling or living outside of the state.