Also known as Preferred Provider Organization.

This is similar to an indemnity plan, but with a network of providers. At the time in which the insured accesses care, they can choose a provider from a preferred-provider list or go to a non-contracted provider. Preferred providers are doctors, hospitals, and other contracted facilities that have agreed to provide services at a discounted fee. This gives insureds an incentive to stay within the network. A higher cost is generally required for medical services obtained from outside the network.

Freedom of Choice! PPO members are not required to seek care from PPO providers. However, there are generally strong financial incentives to do so. For example, members may receive 90% reimbursement for care obtained from network physicians but only 70% for non-network treatment. Additionally, the PPO provider agrees to provide services at a discounted rate so the insured is paying 10% of a lower rate instead of 30% of a full rate.

Also the providers are contractually obligated to bill the insurance company on behalf of the insured and they can't pass charged above the negotiated rates onto the member. And a PPO provider is required to submit claims to the carriers within a reasonable timeframe.

The non-network feature of the plan allows insured's to continue relationships with providers that are not contracted with a network.

Less coverage for treatment provided by non-PPO physicians - For example, members may receive 90% reimbursement of a discounted rate for care obtained from network physicians but only 70% of a non-discounted rate for treatment provided by non-network physicians. And deductibles for non-PPO providers are usually higher then that of a PPO provider. Thus, if your longtime family doctor is outside of the PPO network, you may choose to continue seeing her, but it will cost you more.

More paperwork and expenses than HMOs - As a PPO member, you may have to fill out paperwork in order to be reimbursed for your non-network medical treatment.

HMO stands for health maintenance organization which is the strongest form of managed healthcare. Care is accessed through a primary care physician (PCP) who is responsible for the management of the member's health care. The member has to go to their PCP first for everything,then the PCP will either treat them or refer them to a specialist. PCP doctors are usually General Practice, Family Practice, Internal Medical and Pediatrician doctors. No benefits are provided if the member self refers themselves to specialists or goes out of the network. There are minimal to no co-payments, no annual deductibles, and no claim forms.

Unlike many traditional insurers, HMOs do not merely provide financing for medical care. The HMO actually delivers the treatment as well. PCPs, specialists and hospitals all participate in the business arrangement known as a medical group or Independent Physicians Association

HMO providers provide treatment on a prepaid basis, which means that provider is getting a fixed monthly fee to treat the members regardless of how much medical care is needed in a given month.

HMO members typically pay a low fixed co-payment every time they access care which is more affordable and easier to plan for. In order to keep the cost of HMOs affordable some plans have added in-patient deductibles based on a per day or per admission basis. Also there are NO claim forms! The HMO handles all financial aspects for delivery of care other than the members co-pay.

The focus is on wellness and preventative care. By offering services at a low co-payment members are more likely to go to the doctor when they're first not feeling well. This allows for early treatment preventing the illness from progressing into something more severe. Additionally, many HMOs offer health education classes and discounted health club memberships.

Typically no pre-existing conditions or lifetime maximum apply - Unlike most health insurance plans, HMOs generally do not impose pre-existing conditions or a limit on your lifetime benefits. The HMO will continue to cover your treatment as long as you are a member.

PCPs are also known as the "gate-keeper" and can make it more difficult to get to a specialist. As an HMO member, you must choose a primary care physician (PCP). This "gate-keeper" process helps reduce costs both for the HMO and for the member, but it can also lead to complications if your PCP doesn't provide the referral you feel you need.

In the past HMOs were more affordable then PPO plans but now because of the comprehensive coverage HMOs provide, the cost are equal to and in some situations higher than PPO plans.

Also, since the member has very little financial responsibility when accessing care they may not be as concerned about the costs of services they're receiving. This is one of the contributors to the rising healthcare costs.

Point-of-Service (POS) plans are the best of both the HMO and PPO plans. The delivery method allows for three tiers of benefits HMO/PPO and Non-PPO. At the time the member wants to access care they decide if they want to go to their PCP in the HMO for a low copayment or to a PPO provider or to a non-contracted provider incurring deductible and coinsurance costs.

The insured is in control of the delivery vehicle of their healthcare. They choose the tier they want to access and they have the freedom to make that choice every time they access care.

While the POS option allows for many choices, it can be confusing and overwhelming to the insured. This results in incorrect accessing of care which can be costly. Also the premiums for this type of plan are usually higher then HMO plans and lower then PPOs.

Health Savings Accounts (HSA) plans are a combination of Qualified High Deductible Health Plans (HDHPs) and a special bank checking account called a Health Savings Account. This account is a tax-exempt trust or custodial account established for the purpose of paying qualified medical expenses. It allows you to pay for current qualified medical expenses and save for future qualified medical expenses on a tax-free basis.

The minimum individual deductible for 2007 is $1,100 and $2,200 for the family. There's a maximum annual contribution amount of $2,850 for individual coverage and $5,650 for family coverage.

The annual contributions you make to your HSA account are tax deductible, the interest you earn on the account is tax deferred until age 65 and you pay qualified medical expenses with pre-tax dollars. Also, there's no "use-it-or-lose-it" provision, all the funds in your HSA account are yours even if your employer contributed to the account and you leave the company.

The concept may be overwhelming for some and therefore will cause the insured's not to use the plan and account correctly. High deductibles are required in order for the health plan to qualify for a HSA. Insured's are required to keep records of qualified medical expenses paid with their HSAs. Any funds used for non-qualified medical expenses prior to the age of 65 is subject to tax and a 10% penalty.

Also referred to as a fee-for-service plan, an indemnity plan allows absolute freedom in selecting physicians or medical facilities, and permits self-referral to a specialist. A yearly deductible must be met before the insurance company pays coinsurance. Coinsurance is set at a predetermined percentage, usually 80% in which the insurance company pays that percentage of costs. The doctors have no contractual obligation to submit claims to the carrier, discount services and write off over charges above reasonable and customary.

There are no networks and very little managed care so the insured can access care from any licensed provider. The plans usually require a calendar year deductible then the carrier pays coinsurance, usually 80% until an out of pocket maximum is met then the carrier pays 100% for the rest of that calendar year.

The providers have no contractual obligation with the carrier to discount their services so the member usually pays more then if they were on a PPO. The provider also has no obligation to submit claims to the carrier so the insured may be required to pay for services rendered and submit a claim to their carrier for reimbursement.