Types of Group Health Insurance

Health Maintenance Organization (HMO)

This is a health care system that uses contracted primary care physicians (PCP) to coordinate all healthcare for enrolled members.  HMOs require you to select a PCP who will coordinate your care and refer you to specialists and hospitals.  Usually there are no deductibles to be met and no claim forms need to be completed.  Often these plans are less expensive, but more restrictive.

Point of Service (POS)

This is a type of managed care health insurance plan devised to combine the concepts of HMOs and PPOs.  It allows freedom and low price.  With this type of plan, you must select a primary physician from within your network.  This physician will monitor your care and all medical services must be approved by your physician.  Your Primary Care Physician (PCP) will need to approve all visits to specialists by giving you referrals.  You are not limited to in-network physicians, however.  If you receive care from an out-of-network health care provider, you will need to pay more. 


Preferred Provider Organization (PPO) 

This is a network of health care providers that have agreed to provide medical services to the healthplan's members at discounted prices.   This healthplan has an established provider network that allows maximum benefit coverage when using its own contracted hospitals and physicians.  The plan often reduces benefits when a provider or hospital is used which is outside the established network.  Although the fees are usually more for out-of-network providers, a member may seek treatment from any provider.