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Group Health-Benefit Programs

Sestito Financial Services is a full service employee benefits firm. Our areas of experience encompass a diverse wealth of products and services providing competitive benefit plans which cover Medical plans; including current HSA and HRA high deductible plans, Dental plans, Prescription Drug plans, Long Term Disability, Short Term Disability, Long Term Care and Section 125 plans. We work with an abundance of companies to be sure to get the most comprehensive benefit plans with cost-effective rates and competitive products and services. Sestito Financial Services has partnered with multiple premiere health carriers to offer a wide-range of plan options for you, your business, and your employees.

Health Insurance Plan Types

Preferred Provider Organization (PPO)

The most flexible health plan available, as a PPO provides coverage on both an In-Network and an Out-of-Network basis. To receive the higher In-Network level of benefits, you do not have to obtain a referral from a Primary Care Physician (sometimes called a "PCP" or a "Gatekeeper) when seeking treatment at a hospital or from a specialist. Simply seek treatment from any participating network provider.

Direct or Open Access

Similar to a PPO plan in that both In-Network and Out-of-Network coverage is available and you do not have to obtain a referral from a Primary Care Physician when seeking treatment. Direct Access or Open Access plans provide much of the same flexibility of PPO plans, generally at a lower premium. However, these plans may contain several additional managed care notification requirements and may require that in order to receive hospital benefits on an In-Network basis, the patient must be admitted by a network physician.

Point of Service (POS)

Provides both In-Network and Out-of-Network coverage; however, each member must select a Primary Care Physician (PCP). In order to receive the higher level of benefits, a patient must obtain a referral for a non-emergency admission to a Network hospital or for treatment from a Network specialist. If a referral is not obtained prior to seeking treatment, all expenses will be reimbursed on an Out-of-Network basis.

Health Maintenance Organization (HMO)

Generally the least expensive health insurance coverage; however, at the same time, HMO’s provide limited choice and flexibility, Coverage is only available from Network providers and a member usually has to obtain a referral from their Primary Care Physician for non-emergency admission to a network hospital or for treatment from a network specialist. If a referral is not obtained prior to seeking treatment or if network providers are not used, no benefits are payable.

Note: Employees can minimize the cost of their health care by seeking treatment, whenever possible, from network providers and obtaining necessary referrals when required since Out-of-Network treatment is reimbursed at a lower level and provider charges are subject to Usual & Customary allowances.