Types of Healthcare Coverage Plans
- Preferred Provider Organization (PPO). This type of plan requires that employees see providers who are members of the plan network in order to receive the maximum benefit. Usually, this type of plan requires a copayment at the time of service. Employees also have the option to visit out-of-network providers, but assume responsibility to pay the additional costs associated.
- Health Maintenance Organization (HMO). This type of plan requires that employees use a Primary Care Physician for referrals to specialists. Usually there is a copayment required at the time of service, and employees will not be covered for services from providers outside the network.
- Indemnity plan. These plans typically cover accidents, illnesses, and hospitalizations, but may not cover preventive care. They usually require meeting an annual deductible. After claims forms are submitted, the plan will reimburse a predetermined portion of the bill (often an 80/20 split, with the employee paying 20 percent of the cost, and the plan paying 80 percent). Under an indemnity plan, members can see any provider they choose, providing the greatest degree of freedom and choice.
- Point of Service Plan (POS). Similar to HMOs and PPOs, these plans require members to have a "gatekeeper," in the form of a primary care physician, who manages all care. Where care is received affects the employee's out-of-pocket costs, and employees must use specific providers who are members of the network to pay the lower copayment amounts. Members may also go to out-of-network providers at a higher out-of-pocket costs.
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