Health Insurance Options Guide
A Summary of Plan Options and Services
The chart that follows is intended to help you compare Fee-for-Service (or Indemnity), HMO and PPO plans as well as POS features. Plans will vary. Please consult specific policy descriptions for details on the plans or policies you are considering.
| Plan Type | Claim Forms | Financial Structure | Preventive Care | Providers |
|---|---|---|---|---|
| Fee for Service (or Indemnity) |
Patient files claim forms (Physician or other Provider may file as a courtesy.) |
Deductible probable; co-pay on percentage basis | Not generally covered | Patient (member) can use any physician or facility; may require pre-approval process* |
| HMO | No claim forms | No deductible when service in network; typically low, pre-set co-payment | Emphasized: checkups, immunizations and early detection screenings covered | Usually use plan-approved providers accessed through a gatekeeper* (a primary care HMO physician) |
| PPO | No claim forms usually | Similar structure to HMO when service in network | Preventive care may not be covered; screenings are covered under some plans | Gatekeeper usually not required; can elect out-of-network provider usually at higher cost |
| POS Note: Adding a POS feature to a health plan |
Claim forms may be required | In network, similar to HMO; out-of-network services may be higher in cost | Usually covered: checkups, immunizations and early detection screenings | No gatekeeper required; can elect out-of-network provider with pre-approval* |
Updated on: 3/8/2019