Useful Definitions
- Health Maintenance Organization (HMO):
- A Health Maintenance Organization is a health care plan that provides
benefits to any person or group of persons on a prepaid basis.
Comprehensive health coverage is provided for enrollees through hospital
services and physician services.
- Indemnity Plan:
- An Indemnity Plan is a health care plan that reimburses
physicians for services performed or beneficiaries for medical expenses
incurred. The plans are different from group health plans (HMOs, PPOs,
etc.) that provide services through group medical practice.
- Point-of-Service Plan (POS):
- A Point-of-Service Plan is a health care plan that
allows the patient to choose between an indemnity plan, a PPO, or an HMO
each time he/she needs health care services. POSs are also known as open
ended HMOs. Although the member is encouraged to choose a primary care
physician, it is not required. Higher rates are assessed for individuals
opting to use non-network physicians.
- Preferred Provider Organization (PPO):
- A Preferred Provider Organization is a group of
providers who agree to provide services at discounted rates in return for
prompt payment and an increased volume of patients. Individuals enrolled
in a PPO may accumulate out-of-pocket expenses, costs for services
received outside the provider network.
- Primary Care Physician:
- A Primary Care Physician is a doctor who has the
responsibility of overseeing and coordinating all aspects of a patient's
medical care. If a patient's needs require a specialist and it is not an
emergency situation, the primary care physician must provide a referral
for the patient to see the specialist. Primary care physicians may also
be referred to as gatekeepers.
|
Carrier Links
|
