Types of Health Plans

Other than an indemnity plan, PPO’s offer the most flexibility of all plan types. The insured can choose to go in or out of network, and can access specialist without referrals. PPO Plans generally offer co-payments for doctor office visits and prescriptions.

The basics of health insurance
PPO – Preferred Provider Organization
HSA – Health Savings Accounts - HDHP

Health Savings Accounts are not an insurance product. It is a bank account which allows patients insured on a High Deductible Health Plan (HDHP) to deposit funds into the account for medical, dental and vision treatment tax free.

HDHP – High Deductible Health Plans

High deductible health plans are generally written on a PPO platform which allow the insured the freedom to receive treatment from both in and out of network providers. High deductible health plans are deductible first, and adds a “shopping factor” which allows for lower premiums.

HMO – Health Maintenance Organization

HMO plans differ from traditional health insurance by the contracts it has with its providers. Most HMO plans do not provide benefits out of network, and generally have a “gatekeeper” doctor who directs the patients care. The “gatekeeper” doctor is commonly known as a primary care physician.

Open Access HMO – Health Maintenance Organization

An open access HMO is a combination of an HMO and PPO. The plan is an HMO, but most allow the insured to receive benefits out of network, and does not have a “gatekeeper” doctor.

EPO – Exclusive Provider Organization

Much like an HMO, EPO Plans do not pay benefits out of network and generally have smaller networks. By nature of the smaller network, the EPO can offer richer benefits and or lower prices.

Indemnity Health Plans

An indemnity plan is one of the oldest plan designs. It “indemnifies” (makes whole)  the insured for losses after deductible, co-insurance to a specified maximum out of pocket. These plans have no network and the insureds were/are subject to usual, reasonable and customary charges.

Always check your provider network and certificate of coverage for your specific plan provisions.