Types of Health Insurance

PPO Plans

Preferred Provider Organizations (PPO) are health plans with a large number of providers and facilities which a member can choose from. A member of a PPO plan can seek services from a specialist without a referral. PPO plans offer more flexibility for members who are able to use benefits both in-network and out-of-network although out of pocket expenses will be higher for out-of-network benefits. The most cost efficient benefits are derived from using in network providers.

HSA Plans

Health Savings Accounts (HSA) and HDHP compatible health plans, also called high-deductible health plans, allow members flexibility in choosing a provider and the opportunity to save money in a tax-free Health Savings Account. These plans are subject to the IRS rules for HSA compatible health plans and money put into the HSA must be used for HSA qualified expenses only.

HMO Plans

Health Maintenance Organizations (HMO) are health plans which cover services provided by doctors and hospitals in a network of contracted providers. With an HMO plan, the member is assigned a Primary Care Physician (PCP) which coordinates the member’s medical care. A referral from the member’s PCP is required in order to see a specialist. HMO plans usually have a lower out of pocket expense to the member. Networks within an HMO network are somewhat more restrictive than in a PPO.

POS Plans

Point of Service (POS) plans is a hybrid of a HMO and PPO style plans. When accessing the HMO portion of the plan, members see a primary care physician who is in-network. The plan resembles a HMO for in-network services. Like a PPO plan, members have the option of going outside the network to seek services.

EPO Plans

Exclusive Provider organization (EPO) work likes a PPO with the element of HMO having only in-network benefits. As a member of an EPO, you can use the doctors and hospitals within the EPO network but cannot go outside the network for care. There are no out-of-network benefits therefore members would be fully responsible for all costs incurred if they were to go out of network on an EPO plan.