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| HMO |
Health Maintenance Organization
Network based plan
Primary Care Physicians (PCP) / Specialists
Copayments apply
Referrals are required by PCP to see a specialist
Direct Access to Ob-Gyn for routine visits
No claim forms required
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| EPO |
Enhanced Provider Organization
Network based plan
Primary Care Physicians (PCP) / Specialists
Copayments apply
Referrals are not required by PCP to see a specialist
Direct Access to Ob-Gyn for routine visits
No claim forms required
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| POS |
Traditional Point of Service - Dual option plan (In-network / Out of Network)
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In-Network:
Referrals are required by PCP to see a specialist
Copayments apply
Direct Access to Ob-Gyn for routine visits
No claim forms required
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Out-of-Network:
Access to any physician
Annual deductible applies
Co-insurance (80/20, 70/30, 60/40, 50/50%)
Claim forms are required
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| POS NG |
Point of Service Non Gatekeeper - Dual option plan (In-network / Out of Network)
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In-Network:
Direct access to PCP and Specialists
Copayments apply
No referrals necessary
Direct Access to Ob-Gyn for routine visits
No claim forms required
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Out-of-Network:
Access to any physician
Annual deductible applies
Co-insurance (80/20, 70/30, 60/40, 50/50%)
Claim forms are required
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| PPO |
Preferred Provider Organization - Dual option plan (In-network / Out of Network)
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In-Network:
Direct access to PCP and Specialists
Copayments apply
No referrals necessary
No claim forms required
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Out-of-Network:
Access to any physician
Annual deductible applies
Co-insurance (80/20, 70/30, 60/40, 50/50%)
Claim forms are required
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Traditional
Indemnity
Plan |
Traditional Indemnity Plan
Access to any physician
Non-network based plan
Annual deductible applies
Co-insurance (80/20, 70/30, 60/40 or 50/50%)
Claim forms are necessary
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