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Preferred Provider Organization (PPO)
If your District offers a PPO Plan, you can use the doctors and hospitals within the PPO network or go outside of the network for care. You don't need a referral to see a specialist.
However, if you go outside of the network, you'll pay more - maybe a lot more.
For example, let's look at a hospital bill of $3,000. A PPO may pay 90% for in network and 70% for out of
network. That means you will be responsible for:
10% of $3,000 (or $300) in network or
30% of $3,000 ($900) outside the network.
Most PPO plans also have an annual deductible as well as a
a copayment for doctor visits. These copayments are typically higher than an HMO copayment but not always.
Health Maintenance Organization HMO
With an HMO, you select a primary care physician (PCP) from a list of doctors in that HMO's network. The primary care physician will be the first medical provider to contact for a medical condition. The PCP will make any needed referrals to a medical specialist. Typically, these specialists will be in the HMO network.
When you obtain care without the PCP's referral or go outside the network, you may be responsible for paying the entire bill (with exceptions for emergency care). With some HMOs, no payment is required when you visit in-network doctors. With other HMOs there may be a small copayment for the visit or service.
Typically, an HMO will not have an annual deductible. If you sign up for an HMO, you should find that you have few out-of-pocket expenses for medical care -- as long as you use doctors or hospitals that are part of the HMO.
Point-of-service (POS)
A POS is a type of managed care plan combining features of health maintenance organizations (HMOs) and preferred provider organizations (PPOs). Employees can choose whether to go to a network provider and pay a flat dollar or to an out-of-network provider and pay a deductible and/or a coinsurance charge.
High Deductible Health Plan
A High Deductible Health Plan (HDHP) with a Health Savings Account (HSA) or a Health Reimbursement Arrangement (HRA) provides traditional medical coverage and a tax free way to help you build savings for future medical expenses.
The HDHP gives you greater flexibility and discretion over how you use your health care benefits.
The HDHP features higher annual deductibles (a minimum of $1,050 for Self and $2,100 for Self and Family coverage) than other traditional health plans. Using in-network providers will save you money.
With the exception of preventive care, you must meet the annual deductible before the plan pays benefits. Preventive care services are generally paid as first dollar coverage or after a small deductible, or copayment.
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