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The Distinction among HMOs POS and PPOs

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The Distinction among HMOs POS and PPOs

The Distinction among HMOs POS and PPOs

HMO's, PPO's, along with POS's is the major health insurance options of small business establishments. But there are differences that exist in between. This article explains it.

Choosing a suitable health care plan for your small business can be tough, if you are not aware of the features of the different plans in the market. Generally, when we opt for purchasing managed care plans, we are offered with 3 variants of these health policies. They are HMO's (Health Maintenance Organizations), POS's (Point-of-Service Plans) and PPO's (Preferred Provider Organizations).

The idea behind managed care policies is to offer the benefits of a full health care package to the customers, enabling them to make more savings and avail the best standard of health care services. Although leading organizations provide a host of different plan options, but, a small enterprise will be able to make savings on their purchase, by evaluating different plans against each other, prior to the open enrollment period and selecting the suitable one. However, apart from considering the cost of the insurance plan, you must also analyze the plan's network coverage, services, ease of processing claims and others.

In case you go for an HMO, you naturally choose an HMO doctor who will play the role of a primary care physician in your case. Your medical treatment, basic health care requirements, recommendations to any specialists will be managed by the primary care doctor. However, if you decide to get medical treatment from any other doctor who is not within your plan's network, then you may do so by spending extra dollars. HMO subscribers can opt for treatment on emergency without a recommendation.

Before buying an HMO plan, remember to check the number of doctors and hospitals who are within your plan's network. HMO's have copayment option for every doctor or hospital visit you make but you don't have to go for coinsurance option with these plans.

PPO's function similarly like an HMO but offers more flexibility. PPO plans allows its members to get treatment from doctors and hospitals outside the plan's network in addition to providing some partial coverage for such treatment. However, it requires you to pay coinsurances. PPO's relieves you from taking permission for visiting any specialist and also doesn't make it obligatory for you to choose any primary care provider.

It must be mentioned that both PPO's and HMO's may contain the option of prescription drug coverage. That is however limited to few of the plans of these two variants.

POS is in fact a union of PPO and HMO's. It requires you to select a primary care doctor, but also allows you to visit doctors out of the plan's network upon extra payments. Because of the amalgamation of the benefits of the PPO's and HMO's, a POS is another favorite health insurance option of small enterprise owners. But before choosing any such plan, it is better to go through each of the offer details of the plan's booklet.


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