Choosing Your Health Plan
Our Employee Benefits 101 presentation is available as a recording and slideshow:
- Employee Benefits 101 (video)
- Employee Benefits 101 (slideshow)
This presentation includes information about health plans, FSA accounts, life and disability insurance, and open enrollment. For information about PERS or VOYA, contact: pers@multco.us or deferred.comp@multco.us.
Choosing a health plan can be a difficult decision, especially if you are unfamiliar with different plan types. This document aims to provide some clarity, but please reach out to us at employee.benefits@multco.us with any questions.
When deciding on a plan, here are some things to consider:
- How is your health? How often do you need medical care?
- What is your budget for healthcare?
- What type of medical care do you prefer? Do you like to thoroughly research your care and providers, or would you like assistance and guidance from a primary care physician?
- Do you have specific providers that you want to see? Do you often need care from a specialist?
- Do you prefer the convenience of centrally located services due to your transit needs? Or are you able to easily get to multiple providers/locations?
For medical coverage, the County offers plans from an HMO (Kaiser Permanente) and a PPO (Moda Health). Here’s more about what those plans mean.
HMO (Health Maintenance Organization) plans:
- Are overall lower in cost and have predictable costs
- Care is coordinated through a primary care provider (PCP), which includes referrals to specialists
- Centralized services - offices, pharmacies, imaging, labs all in one place. Your health history, including all imaging and lab results, while you are a Kaiser member, is in the same system and viewable by all of your providers.
- No claims to submit unless you see an outside provider
PPO (Preferred Provider Organization) plans:
- Are higher in cost and costs can vary for some providers/services
- You coordinate your own care, choosing your own doctors and specialists (no referrals needed)
- You can see providers who are in-network (lower cost) or out-of-network (higher cost)
- You may need to provide records to your provider
- No claims to submit unless you see an out-of-network provider
We also encourage you to do additional research online about HMO and PPO plan types for more robust information. Here are some places you can start:
- HMO vs PPO Plans from Kaiser Permanente
- PPO FAQs from Moda Health
Comparison summaries of the County’s plans and costs can be found on our Medical/Dental Plan Costs and Comparisons page
Unfamiliar with insurance terminology? Here are some basics.
Alternative Care generally refers to naturopathic, acupuncture, chiropractic and massage services. Kaiser and Moda both include coverage for alternative care.
Cost Share is the amount you pay semi-monthly for your health coverage and is deducted directly from your paycheck.
Coinsurance is the percentage of covered health costs that you pay after you've met your deductible.
Copay refers to the amount you pay for office visits and services.
Deductible is the amount you must pay before you start seeing savings. Our Moda PPO plans (available to full- and part-time staff) and Kaiser Maintenance plan (available to part-time staff only), have deductibles.
In-network providers are contracted to provide care within the health plan’s network. Kaiser providers are almost entirely in-network. Moda providers can be in-network or out-of-network. In-network providers offer the lowest cost care.
Out-of-network providers bill you directly. You pay upfront costs and then submit a claim for reimbursement of covered charges.
Out-of-pocket maximum is the most you will pay per year for covered services.
Premium cost share is the amount you contribute for your coverage.