Bifalgorithm post · Health Education · Health Insurance: Key Terms
Plan Networks
Plan Networks (Health Education · Health Insurance: Key Terms) — "Part of health literacy is understanding key health insurance terms. This will allow for educ…
Ideas in this flowchart
- Understanding key health insurance terms is part of health literacy.
- Understanding these terms supports educated decisions when choosing a health insurance plan.
- Health insurance provider and network terms
- In-network providers are contracted with the health insurance plan and offer services at contracted or discounted rates.
- Out-of-network providers are not contracted with the health insurance plan.
- Out-of-network coinsurance usually costs more because there is no contracted or discounted rate.
- Health insurance plan types
- An EPO covers services only from doctors, specialists, or hospitals in the plan’s network, except in an emergency.
- An HMO usually limits coverage to care from doctors who work for or contract with the HMO.
- An HMO generally does not cover out-of-network care except in an emergency.
- An HMO may require members to live or work in its service area to be eligible for coverage.
- HMOs often provide integrated care and focus on prevention and wellness.
- A POS plan costs less when members use doctors, hospitals, and other providers in the plan’s network.
- POS plans require a referral from a primary care doctor to see a specialist.
- A PPO plan costs less when members use providers in the plan’s network.
- PPO members can use out-of-network providers without a referral for an additional cost.
