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Types of Health Plans

HMO Plans
Health Maintenance Organizations or "HMOs" are health plans which are prepaid. Members pay their HMO a monthly premium in return for coverage of all medical costs, provided the physicians are included in the HMO approved network and the procedures performed are within the scope of coverage. The rates are negotiated at the time of sign up. A primary care doctor must be chosen by the member. This doctor is expected to plan all medical care and treatment for the member as well as make referrals to the necessary specialists. All expenses for medical services provided to the member outside of the officially approved network or hospitals and providers will are incurred by the member. The idea behind an HMO is that to keep costs low, it is necessary to provide preventative health care before a member falls ill. HMOs are built upon a network of hospitals and physicians who are interested in providing health care to members in exchange for a monthly charge paid by the HMO. Members may see their primary care doctor as often as necessary, paying the HMO monthly premium plus a small additional fee per visit or prescription. Most health and wellness services are covered. Members may not go to a medical provider outside of the HMO network. HMOs only take on employer groups, but occasionally a few will accept individuals as members.

PPO Plans
A Preferred Provider Organization or "PPO" is a network of medical providers who offer health and wellness services to the members of participating health plans for a lower-than-usual cost. These doctors and hospitals are generally made available to members of a health plan by lists issued by their health care provider indicating that should a member receive health care through these listed care givers then their expenses will be covered by full benefits. Members of a PPO make their own health care choices as opposed to HMO members, who receive medical services through a primary care physician. Using a provider outside of the PPO network is more expensive than choosing one recommended by your PPO. However, should a PPO member choose a physician or hospital outside of the network, the health provider may still cover a percentage of the costs, though, in some cases, no claims made outside of the network will be covered at all. Be sure to verify that your chosen doctor or hospital is contracted as a provider with your PPO before undertaking any procedures or appointments. If your physician is not a network member, ask for a referral to one who is or for a hospital for which the provider agrees to pay claims at a 'preferred' rate.

Short Term Health Plans
Short-term Health Insurance Policies are convenient options for those periods when your health insurance lapses for any reason, including: a move, going on strike, waiting for a new plan to start, or switching jobs. Should an emergency arise, these policies will cover you while allowing you to choose your own physicians and health care facilities for treatment as well as pay all the expenses that are covered by the plan once you have paid your deductible and coinsurance. Incidents that are covered by most short term health insurance plans include: