Health Plans
Types of Health Plans
Health Maintenance Organization
In an HMO, your medical care is managed by a primary care physician (PCP) that you choose. If you need to see a specialist, be admitted to a hospital, have lab or X-ray work done, your PCP has to refer you. In an HMO, you are required to stay within the HMO network to be eligible for benefits and having the cost covered.
PPO (Preferred Provider Plan)
What makes a PPO different than HMO is its "open access" nature. Open access means that while you stay within a network to receive full coverage, it is not requried that you choose a PCP. You may go to any network provider you choose, even a specialist, at any time. A referral for hospital, outpatient or ancillary services is not necessary.
POS (Point of Service)
A POS has similar features to an HMO, in that your medical care is managed by a primary care physician (PCP). Your PCP becomes your personal physician, the doctor you see for routine medical care including annual physicals, immunizations and health concerns. Referrals in-network are handled by your PCP and have a small co-payment at the time of service. An additional benefit in a POS is that you have the ability to self-refer to any physician, but with higher out-of-pocket costs.
Traditional
In a Traditional Plan you have complete freedom of provider choice. Services that have been deemed medically necessary are paid out on a variety of cost sharing co-pay and deductible options.