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Medical Insurance

What is a PPO?

A PPO Plan, or a Preferred Provider Organization, is a type of managed care coverage based on a network of doctors and hospitals that provides care to an enrolled population at a pre-arranged discounted rate. PPO members can use doctors outside of the network but they will usually pay more when they choose to go outside the PPO network. If you decide to see a nonparticipating provider, you should know the out-of-network benefits. Your share of the cost would be the out-of-network deductible, plus the coinsurance amount, plus the balance billing amount.

What is a POS?

POS is a Point-of-Service Plan. It is a type of managed care plan that is an HMO with an out of- network option. You can decide whether to go to a network provider and pay a flat dollar or to an out-of-network provider and pay a deductible and/or a coinsurance charge.

What is an HMO?

HMO is a Health Maintenance Organization. As a member of an HMO, you select a primary care physician from a list of doctors in that HMO’s network. Your primary care physician will be the first medical provider you call or see for a medical condition. He or she will make any needed referrals to a medical specialist. Typically, these specialists will be part of the HMO network. If you obtain care without your primary care physician’s referral or obtain care from a non-network member, you will be responsible for paying the entire bill. Normally HMOs have a co-payment for the visit or service.

What is the difference between Group Health Insurance Plans and Individual Health Insurance Plans?

Group health insurance is a policy that is purchased by an employer and offered to eligible employees as a benefit of working for that company. Federal law mandates that no matter what health conditions members may have, no individual employee can be turned down by an insurance company for group coverage.

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