Learn the pros and cons of the most common types of health insurance plans, such as PPOs, HMOs, plans that meet HSA requirements, and compensation plans. Fast and easy access to MetLife customer support services and resources. One of the most common health insurance options is a health maintenance organization, or HMO. This type of insurance provides medical services through a network of doctors, hospitals, and health care providers.1 With an HMO plan, you must seek medical services within the existing network.
HMOs generally don't offer coverage outside the network. If there's an emergency and you receive medical services at an out-of-network hospital, an HMO plan usually covers those expenses with in-network rates, but non-participating doctors who treat you at that facility may continue to charge you. HMO participants choose a primary care doctor for their basic health care needs. This doctor is responsible for coordinating health care services and ensuring that all specialists are in the plan's network.
In the case of an HMO, you usually need a referral from your primary care doctor to see one of these specialists. Another common type of health plan is preferred provider organizations or PPOs. Like HMOs, PPOs come with an approved network of healthcare providers. Unlike HMOs, PPOs usually provide coverage for medical services provided outside of the network.
However, you should expect to pay more out of pocket expenses than if you stayed in your plan's network of approved doctors. Two PPOs don't require you to choose a primary care doctor and may allow you to see a specialist without the need for a referral. This additional flexibility in choosing healthcare providers comes at a cost. PPOs often include higher monthly premiums than HMOs.
An exclusive provider organization, or EPO, offers a network of doctors and hospitals to choose from. They generally have lower monthly premiums than PPO plans, but they have more restrictions. Out-of-network coverage only covers emergencies, for example. In addition to having lower copays and deductibles, EPOs don't always require you to seek a primary care doctor, and you can see network specialists without needing a referral.
A point-of-service plan, or POS, is a type of health insurance plan that requires you to choose a care doctor primary. Usually, a primary care physician coordinates your health care within the approved POS network and referrals to specialists are required. You'll still get some coverage if you visit an out-of-network doctor, but you're subject to a deductible and a higher initial cost. With a PPO, you usually pay less in monthly premiums than with a PPO.
The three most common types of health insurance are a health maintenance organization (HMO), a preferred provider organization (PPO), and a high-deductible health plan (HDHP) with a health savings account (HSA). The best type of health plan for you will depend completely on your specific financial and health care needs. In general, these temporary health insurance plans can cover you from 30 days to a maximum of 90 days. Life and disability insurance, annuity and life insurance with long-term care benefits are issued by The Northwestern Mutual Life Insurance Company, based in Milwaukee, WI (NM).
To compensate for the high deductible, insurance companies that offer HDHPs often allow you to open a health savings account (HA). They allow you to reimburse your employees for eligible medical expenses, including individual health insurance premiums and tax-free out-of-pocket expenses. Because of its flexibility, offering HRA instead of group health insurance is a foolproof way for companies of all sizes, locations and budgets to attract and retain talented workers. The best health insurance policy for you depends on your needs, your budget, your preferred provider network and the benefits of the plan.
Knowing the various health insurance policies will help you evaluate your options during the open enrollment period. Whether you need individual health insurance for yourself or a group health plan for your employees, there are many plan options available. Reviewing available health insurance plans will help you make the right decision for your family or organization during the open enrollment period. You may also be eligible if there is only one or no insurers available in the individual health insurance market in your area. A point-of-service health insurance plan combines the benefits of an HMO and a PPO, allowing you to receive care from both in-network and out-of-network care providers.
A type of health insurance plan that generally limits coverage to care provided by doctors who work for or have a contract with HMO.
