Definitions:
There are four basic types of health plans: traditional indemnity plans,
PPO plans, POS plans and HMO plans. The last three are considered to be
"managed care" plans, but many indemnity plans now have some managed care
features, such as prior authorization.
In general, indemnity plans offer you the best choice of provider, but have
more expensive monthly premiums, deductibles and coinsurance. HMOs have the
least expensive monthly premiums, small copayments, and no deductibles or
coinsurance, but they offer you the least choice of provider. PPO and POS
plans fall somewhere in between.
When you are choosing a health care plan, think carefully about your family's
current and future needs. If you have young children who will need to visit
a doctor frequently, the small copayments offered by an HMO may be a good
choice. If you have a chronic condition that needs a specialist's care, a
PPO plan may be the way to go. Each of us has very different healthcare
needs, and the number of choices can be overwhelming - but they do
allow you to find the best fit for your family. Happy hunting!

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Indemnity Plans
An indemnity plan allows you to go to any primary care doctor, specialist or
hospital that you choose. You or your employer pays the monthly premium.
You also have a deductible (generally around $500 to $1,000) that you must
pay before coverage from you insurance company begins. After your deductible
is met, your health plan pays for a percentage of your healthcare expenses
(usually 80 percent).
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Preferred Provider Organization Plans (PPOs)
In this type of managed care plan, providers (hospitals, physicians and
other healthcare practitioners) agree to provide services at negotiated
fees. You are allowed to go to out-of-network providers, but you receive
greater benefits if you stay within the network. For example, the plan may
pay benefits at 80 percent within the network, but would reduce payment to
60 percent if you see a non-PPO provider. Generally, you have direct access
to specialists, but there are some PPO plans that require you to obtain a
referral from a primary care physician (PCP).
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Health Maintenance Organization Plans (HMOs)
HMOs are healthcare systems that manage both the financing and delivery of a
broad range of healthcare services to a specific group of people. HMOs contain
costs by focusing on prevention and primary care. In general, your medical care
is coordinated and supervised by your PCP, who must also authorize access to
specialists. You pay a small copayment ($5, $10 or $15) for each visit or
service instead of a deductible and coinsurance. Coverage is usually limited
outside the HMO service area, unless it is an emergency situation.
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Point of Service Plans (POS)
POS plans combine features of both HMO and PPO plans. You can choose how you
access the plan each time you need treatment. If you choose to use the HMO
network, your PCP coordinates care, and your out-of-pocket costs are minimal.
If you choose to go outside the HMO network for care, you may select your
physician, but you will have to pay deductible and coinsurance charges.
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