Licensed Product Advisors Plan Type
Health Maintenance Organization (HMO)
An HMO is a network of physicians and other health care providers that provide and coordinate an individual’s health care services. Physicians in the HMO are usually reimbursed on a flat rate based on capitation models. Individuals pay a specific copayment based on the benefit plan design.
Indemnity
Indemnity is a health insurance plan that reimburses the covered person for incurred medical expenses. Indemnity plans often include a deductible that must be satisfied before claims can be paid. Covered persons can usually see any qualified provider without a change in benefits. Indemnity plans are sometimes called fee-for-service plans.
Point of Service (POS)
A health insurance plan that allows the covered person to choose to receive care from a network or out-of-network provider is a POS plan. The benefit levels may vary depending on whether the provider is in the network or not. Covered persons are sometimes required to select a primary care provider (PCP). The highest level of benefits is available when the covered person receives care from the PCP.
Preferred Provider Organization (PPO)
With a PPO, a health insurance plan or network contracts with providers to offer services to covered persons at pre-negotiated fee levels. A covered person may have lower out-of-pockets costs when medical services are received from a network provider. A covered person may visit any provider, but may receive a higher level of benefits when a network provider is seen.