California Employer Resource · Plan Structure
🏥 HMO vs. PPO vs. EPO: Which Network Type Should You Offer?
The letters on your plan card decide how your employees get care — who they can see, whether they need a referral, and what happens if they go out-of-network.
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Looking for the full employer rulebook — the 50-employee mandate, penalties, and tax credits? See the full guide →
🤕 What’s actually different between an HMO, a PPO, and an EPO?Network Types
An HMO requires employees to pick a primary care doctor and get a referral to see a specialist, and it generally only covers in-network care except for true emergencies. A PPO has no referral requirement and lets employees see doctors both in and out of network, trading that flexibility for a higher premium. An EPO is the middle ground: no referral needed like a PPO, but it sticks to an in-network-only rule like an HMO — typically priced between the two.Source: Covered California — Plan and Network Types ↗
📋 Benefits Built for Small Groups
👨⚕️ “Small group medical, dental, vision and voluntary benefits, for groups as small as two employees.”
👩⚕️ “Your employees see plans side by side, with cost per paycheck shown up front. They make better decisions, and fewer questions land on your desk. How many benefits questions does your team field each week?”
💬 Get a Side-by-Side Comparison: Give Your Team Clear Choices💵 Which one is cheaper, and why?Cost
HMOs are usually the lowest-premium option because the carrier can negotiate harder with a smaller, coordinated network and the primary-care-gatekeeper model reduces unnecessary specialist visits. PPOs cost the most because the carrier is on the hook for a much wider network and out-of-network claims. EPOs land in between — an in-network-only PPO without the referral hassle, at a mid-range price.
🤝 Can I offer more than one network type to my employees?Offering Multiple
Yes — most California small-group carriers let you offer a short menu (for example, one HMO tier and one PPO tier) under a single group plan, so employees self-select based on their own doctor relationships and budget. You can also go further and let employees choose freely across multiple carriers, not just multiple network types from one carrier. See how multi-carrier, defined-contribution plans work →
📍 Which should I pick if my team is spread across California — or out of state?Geography
HMO networks are regional — an HMO built around, say, a Southern California hospital system won’t necessarily have in-network doctors near an employee who lives in the Bay Area or moves out of state. PPOs and EPOs generally have broader, often national, networks, which matters a lot for remote or multi-location teams. If your workforce is geographically concentrated, an HMO can work well and save money; if it’s spread out, lean toward PPO or EPO so nobody ends up stuck out-of-network.