What Does the HMO offer you?

The concept of prepaid care is the driving force behind the HMO. It is the oldest form of organized health care. For a predetermined fee, the HMO allows its members recourse to a variety of health care benefits- preventive care not withstanding. There is a wide range of HMOs to choose from. For instance,

• A Group Model HMO entails doctors being employees of the health plan, in which case you would be visiting them at centralised clinics or medical centers.
• Then we have the IPAs or the Individual Practice Associations whereby the HMOs would have entered into contractual agreements with groups of physicians or individual doctors who would consult in private offices.

What does PPO mean?

The Preferred Provider Organization is a type of organized health cares that:

• Closely resembles an indemnity plan. A PPO enters into agreements with hospitals and medical service providers who would charge their services for a lesser fee to the insurers. Therefore if you seek medical services from outside the PPO network, your cost-sharing would be higher than if you consult a doctor from within the network.
• This explains another notable feature of the PPOs- which is the freedom for the insured to make self referrals, consulting with doctors if they so wish, from outside the PPO network. Please note however that you could be reimbursed for only 70% of the cost by the insurer. Additionally you would also need to meet the difference in charges-between what the plan offers and what the provider charges.

What does POS or Point of Service signify?

• Rather than obtain referrals from primary care physicians, the HMO offers the insured patient the right to the concept of self direct care - a facility normally and commonly observed in indemnity plans. When a HMO offers this sort of "opt-out provision", then it is referred to as a POS or a Point of Service Plan. The client's decision on how to act further at this point of service would have a direct bearing on how this Plan would function.
• Should the insured member choose to opt for the services of a medical provider from outside of the HMO and PPO networks, then the reimbursement for the said services would be on the basis of " out-of-network" rules, while a co-payment and a steeper coinsurance would be charged.
• Since those customers who opt for POS Plans also decide where they would seek medical health care, they need to understand the financial impact of their choice.

It is important to choose the best medical indemnity insurance policy. Having an indemnity health insurance policy will protect you and your dependants against any financial constraints arising on account of a medical emergency.

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