PPOs,HMOs explained

<body topmargin=0 leftmargin=0 marginheight=0 marginwidth=0> <table cellpadding=0 cellspacing=0 border=0><tr> <td valign="top" colspan=3 height=65 BGCOLOR="#FFFFFF" TEXT="#080000" bgproperties="fixed" background="05700410egerdp.jpg"> <div> <IMG SRC="1b024240.png" border=0 width="36" height="36" ALIGN="BOTTOM" HSPACE="0" VSPACE="0">hospitalplans.com<FONT SIZE="4" COLOR="#CC0000" FACE="Times New Roman" > </FONT></div> <div> </div> </td> </tr><tr> <td valign="top" rowspan="2" width=144 BGCOLOR="#FFFBF0" TEXT="#080000"> <bR> <div> <B>Back to Home Page</B></div> <bR> <bR> <bR> <div> <B>PPO (Preferred Provider Organization) Coverage:</B></div> <bR> <bR> <div> <B>Fee-for-Service (Traditional or Indemnity) Health Insurance:</B></div> <bR> <bR> <bR> <div> <B>HMO (Health Maintenance Organization) Coverage: </B></div> <bR> <bR> <div> <B>POS (Point-of-Service) Coverage</B><FONT SIZE="2" COLOR="#C0C0C0" FACE="Arial" ><B>: </B></FONT></div> </td> <td valign="top" height=375 colspan=2 BGCOLOR="#FFFFFF" TEXT="#080000"> <div> PPO, HMO, POS, fee-for service types of plans</div> <bR> <bR> <bR> <div> PPO (Preferred Provider Organization) Coverage:</div> <div> A cross between traditional fee-for-service and an HMO. Like an HMO, there are a specific doctors and hospitals to choose from. In a PPO, though, the network doctors have agreed to set prices negotiated by the insurance company. You may use doctors who are not part of the plan and still receive coverage which is not "controlled" at a usually at a lower reimbursement rate. This type of plan is well suited for individuals who live in an area with network doctors and who want an HMO style prepaid plan,. As with HMO's, these plans are geared towards preventative care, often have low copays for office services, and include the services of a traditional plan. A PPO is often described as two plans in one.</div> <bR> <div> Fee-for-Service (Traditional or Indemnity) Health Insurance:</div> <div> This is the traditional kind of health care policy before HMOs & PPOs. Insurance companies reimburse for the services provided directly to the insured. There are no networks - this type of health insurance offers the freedom to choose doctors and hospitals. Thus, one can choose any doctor they wish and change doctors at any time. These plans also allow the insured to use any hospital in any part of the country. Generally a yearly deductible is charged and a percentage of costs above the deductible are covered. An example might include a $250.00 deductible and 80% coverage once the deductible is reached. These plans are generally more expensive and reimburse based on usual, customary and reasonable - not the actual charges.</div> <bR> <div>  </div> <div> HMO (Health Maintenance Organization) Coverage: </div> <div> These are essentially prepaid health plans sold to employer groups. In exchange for a monthly premium, the HMO provides comprehensive care for the insured, including doctors' visits, hospital stays, emergency care, surgery, lab tests, x-rays, and therapy. Care is provided either directly in its own group practice or through doctors and other health care professionals under contract. Generally, the choice of doctors and hospitals is limited to those that have agreements with the HMO.  HMO's may have "out of network" options, depending on the plan and are not commonly sold on an individual basis. HMO's must offer in Ohio "open enrollment" to the general public but the rates are very high as they attract the uninsurable.</div> <bR> <div> POS (Point-of-Service) Coverage<FONT SIZE="2" COLOR="#000000" FACE="Arial" >: </FONT></div> <div> A Point-of-Service medical plan is basically a combination of a PPO and an HMO. This is seldom offered as an individual plan and was used by non-HMO insurance companies primarily to compete with HMOs. Like the other types of managed care, POS plans are established to provide lower cost medical care to those that remain in the network. Assume for a moment that POS's are structured identically to PPO medical plans. The major difference between a POS and PPO plan is that the Point-of-Service plan makes use of a Primary Care Physician. With the POS plans, if you seek medical care outside of the network, you will be responsible for full payment. On the other hand, if your Primary Care Physician gives a referral for you to see a specialist outside of the network, the insurer will pick up most of the cost. As with HMO plans, POS plans typically include preventive care and health improvement programs. </div> <bR> </td> </tr><tr> <td valign="top" colspan=2 height=40 BGCOLOR="#FFFFFF" TEXT="#080000"> <div> <IMG BORDER="0" SRC="1x1.gif" HEIGHT="32" ALIGN="BOTTOM" HSPACE="0" VSPACE="0" WIDTH="66"><B> </B><IMG BORDER="0" SRC="1x1.gif" HEIGHT="32" ALIGN="BOTTOM" HSPACE="0" VSPACE="0" WIDTH="66"><B>  </B><A HREF="id213.htm" TARGET="_top" TITLE="FAQ"><U><B><IMG SRC="05442200.jpg" border=0 width="66" height="32" ALIGN="BOTTOM" HSPACE="0" VSPACE="0"></B></U></A><B> </B><A HREF="id206.htm" TARGET="_top" TITLE="need help?"><U><B><IMG SRC="05342200.jpg" border=0 width="66" height="32" ALIGN="BOTTOM" HSPACE="0" VSPACE="0"></B></U></A></div> <bR> </td> </tr></table></body>