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Understanding Your Health Insurance Options

Health insurance plans are broken down into the following categories:


Preferred Provider Organization (PPO) is a health insurance plan that works with a preferred network of physicians, hospitals, clinics and health care providers of all kinds. Upon a visit to a provider within the network, the insured will pay a pre-set co-pay amount. In addition, there is a deductible that the individual is responsible for before the insurance company begins paying any of the medical costs. Once those amounts are satisfied by the insured, the insurance provider will pay a percentage of the medical bill, usually 80%. If the insured person opts to visit a health care provider outside the network, the deductible will be higher and the percentage that is covered, once the deductible is satisfied will be lower.


A Point of Service (or POS) is a health insurance plan that combines elements of PPO and HMO. With this plan, you select one doctor as your primary care or point of service from the list of participating providers, like you would with an HMO. This doctor will be responsible for selecting specialists when necessary. Just like in a PPO, you do have the option of selecting specialists from outside the network but the difference is you will be required to complete your own paperwork and submit it for a reimbursement.


A Health Maintenance Organization plan provides medical care through a managed system of doctors and medical personnel that work directly for the HMO within the HMO clinic. The primary care physician you select will direct all medical care.


For those who have an Exclusive Provider Organization plan, they will be expected to visit their primary care physician that was selected from a network. A small copayment will be charged but claims will be filed on your behalf. An EPO will charge a deductible. An EPO is similar to an HMO in that it requires you to see a doctor within the network and no reimbursements will be offered for visits outside of that network. Since an EPO typically does not charge the carrier a monthly fee like HMOs do, the premiums are often cheaper. However, the EPO network tends to offer a smaller selection of doctors making it a bit more restrictive.