Similar to PPOs in that it allows members to choose "in network" providers or, for a lower level of benefit, go "out of network". There is a requirement for a Primary Care Physician who directs all the patient's care within the network. Small co-pays and no claim forms apply for "in network" services. Deductible/coinsurance/ claim forms apply "out of network".
A managed care model sometimes called an open-ended HMO, where patients pay an additional fee for care outside the HMO network.
an open access plan that provides the opportunity to use either network or non-network health care providers
a type of managed care program where a primary care physician must be selected
a type of managed healthcare system where you pay no deductible and usually only a minimal co-payment when you use a healthcare provider within your network
a type of system where you pay no deductible and usually only a small co-payment when you use a health care provider within your network
A type of managed care plan that allows members to use out-of-network providers, but at additional cost (usually a higher copayment or a deductible).
An insurance plan that allows a patient to choose doctors and hospitals without having to first get a referral from his/her primary care doctor.
A type of managed care coverage that allows members to choose to receive services either from participating HMO providers or from providers outside the HMO's network. Members pay less for in-network care. For out-of-network care, members usually pay a deductible and coinsurance.
A type of managed care plan combining features of health maintenance organizations (HMOs) and preferred provider organizations (PPOs), in which individuals decide whether to go to a network provider and pay a Co-payment, or to an out-of-network provider and pay a deductible and/or a coinsurance charge.
The latest development in managed care, this type of HMO allows the patient to see either an in-network or out-of-network provider. But patients who go outside the network are reimbursed less (perhaps only 50 to 80 percent of the doctor's fee), and they must submit a claim and pay a deductible plus co-payment charges.
Combines the low out-of-pocket cost associated with an HMO-type plan with the freedom of choice of an indemnity plan. With a POS plan, a subscriber selects a Primary Care Physician from the plan's network of participating physicians. When accessing care through the PCP, or if the PCP arranges specialty care, the subscriber pays little in out-of-pocket costs. However, the subscriber has the ability to directly access care outside of the POS network with an additional out of pocket expense.
Patients can choose which provider to use at the time a health care service is needed. They can choose to be treated by the HMO provider or select a provider outside the HMO. Less restrictive Plan.
An HMO that offers an indemnity-type option. The primary care doctors in a POS plan make referrals to other providers in the plan. However, members can refer themselves outside the plan and still get some coverage as well.
In health insurance, a cost-containment approach in which care provided through a network of providers is managed by a primary care physician or gatekeeper.
a health insurance benefits program in which subscribers can select between different delivery systems (i.e., HMO, PPO and fee-for-service) when in need of medical services, rather than making the selection between delivery systems at time of open enrollment at place of employment.
The newest type of managed care organization which differs from others in one critical aspect. Insureds who decide to go outside the plan for health care services receive reduced benefits.
A type of managed care plan combining features of health maintenance organizations (HMOs) and preferred provider organizations (PPOs) that allows members to choose to receive either from the participating HMO providers for a flat fee, or from providers outside the HMO's network with a lower benefit level.
A program whereby each time health care services are needed, the patient can choose from different types of provider systems (indemnity plan, PPO or HMO). Each choice may provide different benefit payments.
Plan that offers a full range of health services through a combination of HMO and PPO features. Members can choose to either use the defined managed care program (with 100 percent coverage) or go out-of-plan for services (with 80 percent coverage).
Managed care product that offers enrollees a choice among options when they need medical services, rather than when they enroll in the plan. Enrollees may use providers outside the managed care network, but usually at higher cost. (This should not be confused with POS as used in retail pharmacy, where it stands for point of sale.)
A point of service plan, or POS plan, is a type of managed care health insurance system. It combines characteristics of both the HMO and the PPO. Members of a POS plan do not make a choice about which system to use until the point at which the service is being used.