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Four Basic Types Of Major Medical Health InsuranceHealth Maintenance Organizations (HMOs) Health Maintenance Organizations, or HMOs, are major medical health insurance programs for which you pay ahead of a time a monthly premium. Your premium will cover a variety of preventative medical procedures and possibly dental and optical coverage. Consumers who choose to use HMOs must select one main doctor from an approved list of physicians provided by the HMO. To this end, you may find yourself ending a long-term relationship with your doctor simply because they do not belong to the HMO network. Once you have chosen a primary care physician, that doctor is then responsible for all of your medical needs, from actually treating you to recommending specialists for circumstances outside their expertise. Doctor visits, hospital stays, laboratory tests and prescriptions all require a co-payments on the part of the patient who is a member of a HMO. Preferred Provider Organizations (PPOs) Preferred Provider Organizations, or PPOs, are major medical health insurance programs that allow patients to chose whatever doctors they want. However certain physicians that belong to the insurance companies "network" will offer discounted prices for services. For this reason most people who use PPOs for their major medical health insurance needs make it a habit to see only in-network doctors and specialists. PPOs still provide more freedom for patients than HMOs but are usually more costly too. Members of PPOs pay a monthly premium for coverage as well as co-payments at the time of service. Point Of Service Plans (POS) Point of service plans, or POS plans, are an alternate form of Health Maintenance Organizations. They difference between HMOs and this type of major medical health insurance is that POS plans allow you to control which medical professionals you see rather than insisting on recommendations from your primary care doctor. If medical treatment is required, you as the consumer has three "point of service" choices for medical attention: You can visit your primary doctor and the HMO coverage will pay for the service; you can go to a PPO and be covered under their in-network regulations, or you can go to a provider not included in either program and received coverage under the PPOs out-of-network rules. Fee For Service Plans (FFS or Indemnity) Fee For Service (FFS), or Indemnity, plans are the simplest major medical health insurance programs to understand. You, as the patient, can go wherever you want for medical treatment. The medical facility then submits a claim to your insurance carrier who in turn pays the entire balance due. The only problem with FFS plans is that the patient often must meet a large deductible before coverage begins. For individuals who don't usually have expensive medical bills, it is possible that no services will fall outside of the deductible. |
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