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Health Plan HelpCan’t make sense of the confusing terms and jargon used with health insurances? This guide is designed to help you. What are PPOs, HMOs, POS and FFS plans?The most common type of health insurace is known as managed care which covers three groups of plans:
PPOs and HMOs are the most common health insureance plans in use today. However, fee-for-service plans (FFSs) were the standard form of health care plan before managed care came into being. What is a Managed Care Plan?A managed care plan is one that covers the services of health care providers and medical facilities at reduced costs. The companies that provide these plans have negotiated contracts with certain healthcare providers (doctors, hospitals, etc) that enables them to offer cover for an attractive premium. The restriction to these plans occurs when plan members want to use a service that is not in the network. Managed care plans have become one of the most popular form of health care insurance in recent years. What is a Health Maintenance Organization?Health Maintenance Organizations (HMOs) are one of cheapest ways of obtaining health insurence cover. The price of premiums is comparatively low because plan-holders surrender the freedom to choose their own healthcare providers – HMOs stipulate that the providers must be within the HMO network. What is a Preferred Provider Organization?Preferred Provider Organizations (PPOs) have negotiated contracts with healthcare providers (doctors, hospitals, etc) whereby they accept lower fees for their services. This means that premiums for policyholders are reduced but with the flexibility of allowing policy holders to see doctors and specialists who may not be in the plan. The reason this can be offered is that policyholders have to pay higher fees in the form of deductibles and co-payments if they decide to consult with medical professionals outside of the network. What is a Point-of-Service Plan?A point-of-service (POS) plan is one where policyholders can select a primary care doctor who will be responsible for their care within the network. Point-of-Service plans allow policyholders to use healthcare providers who are not part of the plan’s network but there is an extra charge for this level of care. What is a Fee-for-service Plan?Fee-for-service plans are one of the most expensive forms of health insurance because policyholders can choose their healthcare providers and can refer themselves to specialists if they wish. Consequently, the charges are high with significant deductibles. |
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