Monday, March 2, 2020

Things You Should Know About Health Insurance Providers

Many employed people today are enrolled in some kind of health plan provided by their company. These health plans are usually availed from an HMO, Health Maintenance Organization or a PPO, Preferred Provider Organization. There is also an option to purchase from a POS or a Point of service plan. Here are some of the basic facts about HMOs and PPOs to help you figure out health insurance providers.

If you are enrolled in a Health Maintenance Organization then all of your health needs will be serviced by one provider. There are a network of hospitals, laboratories, clinics and pharmacies that you can avail of services from. You are also required to select a PCP or a Primary Care Physician who will be the one to manage your health needs and coordinate with hospitals and clinics on your behalf. A referral is needed from your PCP whenever you need to consult a specialist based in another hospital or clinic that is part of the network.


People who are enrolled in a PPO health care will not need to have a PCP. People can freely choose their own doctors in the vast membership that your PPO will provide. All you need to pay is the annual deductible plus no referrals are required. If you go to a nonmember hospital or clinic then you need to pay more.

People enrolled in HMOs will only need to pay for their prescriptions, doctor visits and procedures. Employees also need to pay their monthly dues together with their employers. There are some PPOs though which has an option for an annual deductible for services that you have to avail of outside of the network. It is great that PPOs can reimburse any health expenses as long as you have an official receipt from the said hospital. HMOs do not cover any expenses from non-network clinics and hospitals.

These are the basic facts that you should know about when choosing between HMOs and PPOs for your health care. It is important that you pick a health care provider that will fit your medical needs well.

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