Basically, most health insurance plans fall into four categories:
- Health Maintenance Organization (HMO)
- Preferred Provider Organization (PPO)
- Point-of-Service (POS)
- Open Access
Unique features of each:
HMO
- Members receive care from a contracted network of providers (physicians, hospitals, specialists, labs, etc.).
- A primary care physician (PCP) coordinates care.
- Members need referrals to see specialists.
- Emphasis on preventive care such as well baby visits, physicals, immunizations, annual GYN exams, and mammography.
More details about Optima Health HMO options.
PPO
- Members have the freedom to select any provider for care, with lower out-of-pocket costs for seeing network providers.
- No requirement for PCP selection.
- No referrals needed to see specialists.
More details about Optima Health PPO options.
POS
- Two plans in one with an in-network side and an out-of-network side.
- Members receive maximum benefits by using a PCP to coordinate care within the provider network.
- Higher out-of-pocket costs and deductibles may apply when members see out-of-network providers or make appointments with specialists without PCP referrals.
More details about Optima Health POS options.
Open Access
- Open Access HMO plans allow members to choose whether to receive care from a PCP or self-refer to an in-network specialist.
- Open Access POS plans give members the option to visit their PCP, self-refer to an in-network specialist, or self-refer to an out-of-network specialist. Higher out-of-pocket costs may apply when members use out-of-network benefits.
More details about Optima Direct HMO Open Access options.
More details about Optima Direct POS Open Access options.
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