Types of Health Plans

Posted: March 9, 2015

There are many different types of health plans. Fee-for- Service, Health Maintenance Organization (HMO), Preferred Provider Organization (PPO), Point-of-Service Plan (POS), High Deductible Health Plan (HDHP). All these health plans and acronyms can be very confusing, see below for more information about the differences in types of health plans.


Plan Definition – Health coverage that reimburses health care providers for services.

Network of Providers – No Network, you can choose any provider.

Deductible, Coinsurance, Copayments – Deductibles and coinsurance Submission of claim forms.

Referrals – Not required.


Health Maintenance Organization (HMO)

Plan Definition – Services performed solely by network providers.

Network of Providers – Out-of-network services usually aren’t covered.

Deductible, Coinsurance, Copayments – Deductibles coinsurance and/or copays.

Referrals – Required, Primary Care Provider coordinates all care.


Preferred Provider Network (PPO)

Plan Definition – Network of providers, but allows for use of out-of-network services.

Network of Providers – Has network, but allows for out-of-network services.

Deductible, Coinsurance, Copayments – Deductibles coinsurance and/or copays; lower using in-network providers.

Referrals – May be required.


Point-of-Service Plan (POS)

Plan Definition – Combination of an HMO and PPO. You choose how you receive your care.

Network of Providers  Must stay in network.

Deductible, Coinsurance, Copayments – HMO: No deductible, has coinsurance and/or copays. PPO: Deductibles, coinsurance and/or copays

Referrals – HMO: Required PPO: Not Required.


High Deductible Health Plan (HDHP)

Plan Definition – High deductible plans often combined with tax-advantaged accounts, such as HRAs & HSAs.

Network of Providers – Not required, but are offered.

Deductible, Coinsurance, Copayments – Higher Deductibles and possible coinsurance after deductible is met.

Referrals – Not required.


Linda Presler

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