Insurer

Health Insurance

What is a PPO?
A PPO is a Preferred Provider Organization. As a member of a PPO, you can use the doctors and hospitals within the PPO network or go outside of the network for care. You do not need a referral to see a specialist.

What is an HMO?
An HMO is a Health Maintenance Organization. As a member of an HMO, you select a primary care physician from a list of doctors in that HMO’s network. Your primary care physician will be the first medical provider you call or see for a medical condition. He or she will make any needed referrals to a medical specialist. Typically, these specialists will be part of the HMO network.

What is a POS?
POS is a Point-of-Service Plan. POS is a type of managed care plan combining features of health maintenance organizations (HMO’s) and preferred provider organizations (PPO’s). You can decide 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.

What are out-of-pocket expenses?
Out-of-pocket expenses include your annual deductible, coinsurance amounts, and any expense deemed not to be “reasonable and customary”.

What are preexisting conditions?
Preexisting conditions are conditions that are excluded from coverage under a health insurance policy. Examples are endless, but include things like knee injuries, back injuries, heart ailments, etc.