Indemnity plansor fees-for-service plans - These plans usually provide the most flexibility in choosing where to receive care and typically have a deductible (the amount you pay before the insurance company begins paying benefits). After your covered expenses exceed the deductible amount, benefits usually are paid as a percentage of allowable expenses, often 80 percent. Benefits may be payable, at some level, for all allowable services from any qualified provider or physician of choice. This is the right plan for you if you wish not to change doctors and your doctors do not particpate in any 'network' plan (PPO, HMO, etc.).
Preferred Provider Organization (PPO) plans - In these major medical plans, the insurance company enters into contracts with selected hospitals and doctors to furnish services at a discounted rate. As a member of a PPO, you may be able to seek care from a doctor or hospital that is not a preferred provider (out-of-network provider), but benefits may be payable at a reduced level. Payments also may be based only on negotiated in-network provider fees and your deductible and out of pocket expenses are higher. These plans may be a good choice if you have budgeted for a comprehensive major medical plan and most of your doctors are contracted PPO doctors.
Point of Service (POS) plans - These major medical plans are a hybrid of the PPO and HMO models. They are more flexible than an HMO but may require you to select a Primary Care Physician (PCP). You can go to an out-of-network provider but are responsible for more of the cost. However, if you need specialty care, not offered by an in-network provider this may be a good plan choice for you. Premiums may be slightly lower and the network of providers different from the PPO. The participating providers of a POS are the same as the HMO list for the same insurance company. This is a good choice if your primary doctors particpate but you desire an option of using non-participating providers.
Health Maintenance Organization (HMO) plans - HMO plans usually require that you select a Primary Care Physician (PCP) to coordinate your care. Visits to specialists typically require a Primary Care Physician (PCP) referral. There is generally no coverage for care received outside of the HMO network, with certain exceptions for emergencies. An HMO may be less expensive than a POS, PPO or Indemnity Plan and a good choice if you do not yet have a doctor or your doctors participate with the HMO plan. Participating HMO providers have agreed to accept lower payments from insurance companies in exchange for an influx of patients. HMO plans are very focused on "well-care" benefits.
Network or Association Health Plans (AHP) - allow individuals or families to buy a health insurance plan more like those available only to groups. An organization with a specific focus, often related to healthy living, offers a selection of plans from which the consumer can choose to purchase. Plans may not contain certain state mandated benefits and premiums may be lower. Under current law, the insurance carrier can, with proper notice, choose to discontinue the coverage, but only if they discontinue the entire class of plans in that state. A small membership fee, such as $5 to $15 is often charged for this type of consumer association plan found on our web-site. Any such fee may be shown and folded into the monthly premium. These plans may be right for you if eliminated mandates are not important coverage for you.