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Group
Health Insurance
Health Maintenance Organizations (HMO)
Health maintenance organizations are prepaid
health plans. As an HMO member, you pay a
monthly premium. In exchange, the HMO provides
comprehensive care for you and your family,
including doctors' visits, hospital stays,
emergency care, surgery, lab tests, x-rays, and
therapy.
Preferred Provider Organizations (PPO)
The preferred provider organization is a
combination of traditional fee-for-service and
an HMO. Like an HMO, there are a limited number
of doctors and hospitals to choose from. When
you use those providers (sometimes called
"preferred" providers, other times called
"network" providers), most of your medical bills
are covered.
Point of Service Plan (POS)
A
Point of Service plan offers participants the
option to choose the type of coverage they want
before each medical service. It combines
elements of an HMO (requiring a primary care
doctor) and a PPO (the ability to receive
services out-of-network and still have coverage
at a reduced rate). If your PCP does not provide
or coordinate your care, this choice pays lower
benefits.
Fee for Service or Indemnity Plans
Coverage in which the insurance carrier
reimburses the insured person for medical
expenses after care has been given. The choice
of physician and hospital is usually completely
up to the patient; there are deductibles and
plans that usually specify a maximum amount that
will be paid for covered services.
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