Click on a link below to find a health care provider within your plan.
There are four (4) basic types of healthcare. Generally, if more restrictions are built into the plan, the lower the cost will be to you. The more freedom of choice you enjoy or lower out-of-pocket costs, the higher the premium.
- Indemnity Plan -
This is the traditional type plan some of us grew up with. You go to any doctor you choose, any time you choose and there is no “list.” After the annual deductible, the plan often pays 80% until the bill reaches the out-of-pocket limit. Then they pay at 100% for the remainder of the calendar year. This is the most expensive type of coverage.
- Preferred Provider Organization (PPO) -
You choose your doctor from a list of providers. These doctors give a discount in their services which are passed along to you in one or more forms: lower premiums, lower co-insurance or the addition of the co-pay feature. Most insurance companies incorporate what is called a swing plan into their PPO. In a swing plan, you have the freedom to obtain services in, or out of the network of doctors. Usually, you are given an incentive to obtain services in network, penalized when you go out of network.
- Point of Service Plan (POS) -
This type of plan is based on managed care. It is the newest type of coverage and therefore not as well defined when you compare from one insurance provider to another. It is a gatekeeper system. You must go to your primary care doctor first. If s/he can’t help you, they will give you a written referral to a specialist within your list of providers. Most companies cover treatment outside the list of providers only in emergencies. A few companies allow you to use a doctor outside the network, similar to the swing plan mentioned above. Women may self refer to an OB-GYN. Provider lists for POS plans are smaller than those of a PPO.
- Health Maintenance Organization (HMO) -
HMO’s put an emphasis on staying well. In that light they have always promoted routine physicals and other well care visits. HMO’s are managed care plans, sometimes without the annual deductible. With HMO’s, managed care is built in to their system. Many of their services are based on co-pays. This means that you pay a co-payment for each service, each time you receive treatment. Like other managed care plans, provider lists are usually smaller than they would be with PPO’s.
Health Savings Account Compatible Plans
Not exactly a separate “type” of plan, “HSA’s” are usually a PPO that meets the federal guideline for a HSA, including a high deductible. They often have limited or no prescription drug benefits. Owners of a qualified HSA plan may open a custodial account. Dollars contributed to this account will become tax-free when used for qualified medical expense. Beside deductible and co-insurance, dental, vision, glasses/contacts, prescriptions, orthodics, chiropractic and other care would be included.
