An HMO as the only option

[Guest HopeCU]

Are there any laws or regulations to make employers have to offer you other Health Insurance options besides an HMO?

[Steve72]

No. In fact, there's nothing saying that they have to offer insurance at all.

[Guest rmg]

Actually, as recently as 2 years ago, Georgia required that ees on group plans be offered benefits "out-of-network", which in my experience allowed an er to offer an HMO and something else or a product that had out-of-network coverage. I don't know what the status is now. Of course, HopeCU isn't in Georgia and Steve72 is right about the er not having to offer insurance at all.

[Kirk Maldonado]

Wouldn't the Georgia law be preempted by ERISA (at least with respect to self-funded plans)?

[GBurns]

Even if ERISA pre-empts the employers plan it still does not pre-empt the insurance providers policy.

In general insurers providing services to residents of a state must file ang get approval to use the product within that state or must do an informational filing showing that the policy has been approved in the state of domilcile.

ERISA has to do with the employers plan which can be insured or not insured. If insured there are other rules if self insured the plan itself is exempted by ERISA but the service providers are not.

[Mary C]

The Georgia law is "Consumer Choice Option". Basically its a form of any willing provider regulation. The participant submits his provider's name to the HMO, POS or PPO and the HMO then contacts the doc. If the doc is willing to accept the contractual rate from the HMO, POS or PPO and their utilization management, then the participant receives "in network" benefits (usually only has to pay the co-pay) from a doc that isn't "in network". The insurance companies may charge an additional 10-17% premium for individuals electing this option.