HMO, PPO, POS, etc
HMO (Health Maintenance Organization) is an organization that provides or arranges for coverage of certain health care services. Typical HMO coverages include access to a primary care physician, emergency care, and specialists/hospitalization when needed.
Kaiser Permanente is the largest HMO provider in North California. Many Kaiser Permanente hospitals bring physicians, emergency care, pharmacies, and medical labs under a same facility.
Comparing with ohter types of medical insurance plans, HMO normally has the lowest premium. However, some critics of HMOs address concerns as to a lack of selection of primary care physicians and making health care decisions based upon a pure profitability standpoint as opposed to decisions driven by providing the best level of care for its patients.
PPO (Preferred Provider Organization) is a form of managed care under which health care providers contract to provide medical services at pre-negotiated rates. Members who subscribe to a PPO are required to use the health care providers who participate in the PPO network – utilization of a health care provider outside the PPO network may result in the member paying more out-of-pocket for services which could have been provided within the network.
Blue Cross is the largest PPO provider in North California.
IPO (Independent Provider Organization) operates by having an HMO contract directly with independent physicians to provides services to HMO members.
POS (Point of Service) plans allow the individual policy holder or certificate holder to visit out-of-network, non-participating doctors for a fee. If the services of a non-participating health care provider are utilized, the individual often obtains restrictions of benefits or incurs more out-of-pocket costs.HMO: An HMO (Health Maintenance Organization) is an organization that provides or arranges for coverage of certain health care services required by members of the organization. Typical HMO coverages include access to a primary care physician, emergency care, and specialists/hospitalization when needed.
