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Diet, exercise, and caution should be a part of everyone’s daily regimen. But, injuries and illnesses can still occur unexpectedly. Having health insurance will allow you to get necessary treatments without incurring hefty bills. By understanding the options available, you can pick the plan that best suits your needs.

What Are the Different Kinds of Health Insurance Plans? 

1. Health Maintenance Organizations (HMO) 

HMO plans are used by individuals and families who regularly see their primary care provider (PCP) for check-ups and other health matters. 

Those with HMO health insurance have access to a diverse network of physicians to choose from. After selecting a PCP, they will act as a coordinator, with patients going to them for check-ups and referrals to specialists. 

HMO plans cover most types of health improvement programs and preventative care visits. Emergency care is only covered if the PCP writes a referral first. Some plans have co-pays and annual premiums while others do not, but patients must only use physicians in their plan. If they don’t, they will have to pay for the visit or treatment out-of-pocket. 

2. Preferred Provider Organizations (PPO) 

Health InsurancePPO plans incentivize policyholders to only use in-network physicians by offering lower fees and reimbursements. 

Patients can also refer themselves to specialists without needing a referral from their PCP. As long as they stay within the network, the co-pay remains the same. However, depending on the plan, preventative care may not be covered. 

Seeing an out-of-network doctor may mean that the policyholder will have to pay for the entire visit upfront. The bill can then be forwarded to the health insurance provider for a reimbursement of up to 80%. Some PPO plans require a deductible for going out-of-network or have the policyholder pay the difference between the in-network and out-of-network fee. 

3. Exclusive Provider Organizations (EPO) 

Those with EPO plans have coverage for in-network physicians and they don’t always need to select a PCP. The plans will not cover out-of-network visits unless there is a medical emergency. 

While some EPO plans have deductibles, the premiums are notably low. 

4. Point of Service (POS)

POS plans require the selection of a PCP. Like PPO plans, they provide some coverage for out-of-network visits. 

They also provide more coverage for preventative care and health improvement programs. Those with POS plans can receive coverage for smoking cessation classes, health workshops, and fitness centers. 

 

Navigating health insurance plans can get confusing. To simplify the decision, reach out to the Harris Insurance Agency in Centerville, OH. As an independent insurance company, they maintain relationships with many providers to help their clients get the plan they need at an affordable rate. Their agency is open to individuals and families alike and will work with you to select your first plan or move you to another. For more information, reach out to them on Facebook. To schedule an appointment, call (937) 387-6672.

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