A Medicare Managed Care Plan option that lets you use doctors and hospitals outside the plan for an additional cost.
A health benefits plan that lets members access both participating and nonparticipating providers. Accessing care through a primary care physician (PCP) gives members in-network coverage levels while self referred care is covered at a lower, out-of-network benefit level.
A benefit plan that provides two levels of coverage options to Members. A Member may access Covered Services through their Primary Care Physician or Self-Refer to any Provider.
A point-of-service (POS) plan is an option added to many HMOs allowing enrollees to seek care outside of the HMOs network for a higher co-pay and, possibly, a higher premium.
The most recent configuration within the health network models, the POS is a hybrid that uses an HMO to provide what is termed in-network care, where the patient usually pays only a co-payment. However, enrollees can seek out-of-network care under the terms of traditional indemnity plans with a deductible and a percentage co-insurance.
An HMO option in which the participant receives full benefits when care is coordinated within the HMO's network. For additional out-of-pocket costs and a higher premium, a participant may see providers outside the HMO's network.
The Point-of-Service plan allows members to use the HMO network or a provider, which is not on the network, by paying a deductible and co-insurance. Note that non-network providers are subject to the same managed care requirements as network providers.
Under this plan, you choose a primary-care physician. If you need a specialist, you may choose a doctor not working directly with your PCP. You may be required to pay for this specialist out-of-pocket, depending on your policy.
(POS) Plan 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 flat dollar co-payment (say $10 for a doctor's visit), or to an out-of-network provider and pay a deductible and/or a coinsurance charge.
A health plan arrangement in which consumers may choose to receive a service from a participating or a non-participating provider or facility. Generally, the level of coverage is reduced, or the consumer pays more out-of-pocket, for services associated with the use of non-participating providers.
A type of managed care plan that allows the covered person to choose to receive a service from a participating or a nonparticipating provider, with different benefit levels associated with the use of participating providers.
A type of managed care plan that provides financial incentives to encourage members to use network providers but allows members to choose providers outside the plan.
health plan which allows the enrollee to choose HMO, PPO or indemnity coverage at the point of service (time the services are received).
Often known as open-ended HMOs or PPOs, these plans encourage use of network providers, but permit insured individuals to choose providers outside the plan at the time service is rendered.
An HMO option that lets you use doctors and hospitals outside the plan for an additional cost.
arrangements in which patients with a managed care dental plan have the option of seeking treatment from an "out-of-network" provider. The reimbursement for the patient is usually based on a lower table of allowances with significantly reduced benefits than if the patient had selected an "in-network" provider.
A product offered by a health plan that has both in-network and out-of-network features. In a POS you don't have to use the plan's network of providers for every service but you generally pay more out of network.
A type of benefit plan that combines features of HMO and indemnity insurance. Members must select a primary care physician who is part of the plan's network and pay a co-pay at each visit. The primary care physician coordinates members' care and refers them to specialists and healthcare facilities within the network. Members may use physicians who are not part of the network but this triggers indemnity-style coverage, under which the member must first meet a deductible and, thereafter, pay a percentage of total fees.
An option offered by some Medicare Managed Care Plans that allows an individual to use doctors and hospitals outside the plan at an additional cost.
A managed care program that is a hybrid of fee-for-service and a PPO or DHMO. At enrollment, patients select a participating dentist, but at the time of treatment may go to any out-of-network dentist at a reduced fee.
A healthcare option that allows members to choose at the time medical services are needed whether they will go to a provider within the plan's network or seek medical care outside the network.