Why PHP - Employers

PHP’s original healthcare product has been keeping members healthy for more than 30 years. In that time, PHP has developed a reputation for assisting members and their providers with managing their care.

PHP’s HMO (Health Maintenance Organization) product has a broad network in mid-Michigan. Members have the freedom to see any provider within the PHP Service Network without a referral. PHP’s POS (Point of Service) product allows your employees to see any provider they choose, in-network or out of network.

PHP also offers several plans compliant with the Mental Health Parity Act and Addiction Equity Act and that also work well with health reimbursement arrangements.

PHP’s PPO (Preferred Provider Organization) insurance plans, available to employers located anywhere in Michigan, give employees the freedom to see the providers they want at a low cost.

Take a look at our plan offerings and call your insurance agent or a PHP Customer Service Specialist at 517.364.8484 or 888.892.0009, for a quote today.

A high-deductible health plan (HDHP) is an inexpensive option that generally doesn’t start paying for enrollees’ healthcare expenses until a high threshold is met (usually a several thousand dollar deductible) but typically covers them after that. Preventive care is covered at 100 percent and is not subject to the annual deductible. There is no coverage for preventive services out of network.

Other plan features:

• All services, except preventive care, apply to the deductible

• Deductibles, coinsurance and prescription copays all apply to the out-of-pocket (OOP) maximum

• The family deductible and out-of-pocket (OOP) maximum are nonembedded, meaning no individual in the family has satisfied the deductible or OOP maximum until the entire family amount has been satisfied 

• There are separate accumulators for in-network and out-of-network deductibles and out-of-pocket maximums 

• Except for prescription drugs, these plan designs do not include any flat-dollar copay

To help members pay for medical expenses until their deductible is met, employers can set up a health savings account (HSA) for employees. Employers, employees or both can contribute to the HSA. Learn more about HSAs below.

Beyond our core products, PHP also offers a number of ways to customize the health coverage you offer your workforce. These include additional medical services as well as techniques for reducing your and your employees’ healthcare costs.

Health Savings Accounts (HSA)*
A health savings account is an alternative to traditional health insurance; it is a savings product that offers a different way for consumers to pay for their healthcare. HSAs enable employees to pay for current health expenses and save for future qualified medical and retiree health expenses on a tax-free basis.

An HSA is a savings account into which employees can deposit money on a tax-preferred basis. They must be covered by a high-deductible health plan (HDHP) to be able to take advantage of an HSA. An HDHP generally costs less than traditional healthcare coverage, so the money employees save on insurance premiums can go into the health savings account.

Employees own and control the money in their HSA. Decisions on how to spend the money are made by them without relying on a third party or a health insurer. Employees also decide what types of investments to make with the money in the account in order to make it grow.

Flexible Spending Accounts (FSA)*
A FSA is an employer-sponsored benefit that allows the employee to save pretax dollars for medical expenses not usually covered by healthcare insurance. This usually means deductibles, copayments and coinsurance, but it can also include expenses such as dental and vision charges and over-the-counter drugs.

Generally, allowable items are the same as those under the medical tax deduction. The Internal Revenue Service’s annual cap for a medical FSA is $5,000; however, employers may set a lower cap on the amount the employee may contribute. Employees contribute a predetermined amount, up to the cap, which is taken from their paychecks before taxes are calculated.

When an employee has an eligible medical expense, he or she submits a claim to the FSA and is reimbursed up to the amount the employee elected to contribute to the account. Reimbursements from the FSA are not taxed.

Prescription Drug Plans (HMO/POS; PPO)*
PHP also offers several prescription drug plans to choose from. All prescription plans include coverage for mail order – a 90-day supply for two retail copays.

Essentials Rx Plans*
PHP’s new Essentials Rx Plans give employers the opportunity to offer a prescription drug package with the qualities employees are looking for – and at a price that fits within the business budget. Learn more about PHP prescription information in the Members - Get Your Medication page.

*These ancillary products are purchased in conjunction with medical plans and cannot be bought separately.

PHP can provide third-party administrator (TPA) services for large employers that want to self-insure their employees’ health coverage. PHP can also provide network access and medical management services to self-insured companies.

What Is Self-Insurance?
Self-insurance, or self-funding, allows an employer to pay claims rather than insurance premiums. It means you would assume some or all of the risk. A TPA, such as PHP, can administer and pay the claims for self-insured benefit plans.

Why Self-Insure?
With the right TPA, a self-funded benefit plan can save money on health benefit costs and allow for flexibility in plan offerings – from HMO to POS and PPO plans.

Should My Company Self-Insure?
Whether or not a company should self-insure depends on a number of factors, which could include the number of employees, their general health and their location, as well as the amount of risk a company is willing to assume and its past claims history.

PHP offers stop-loss insurance to employers who self-fund their employee benefits through PHPMM-TPA. Stop-loss coverage protects employers against the severity of large losses from claims. Stop-loss coverage is available in two types:

1. Specific which protects against the severity of large losses from a single individual’s claims.
2. Aggregate which protects against a high level of total claims.