Compare Types of Health Insurance Plans
Do you know the difference between HMO, PPO, and POS health insurance plans?
Even if you think you're sure you do, it's worth making sure you understand the differences when you're considering what type of coverage best meets your needs.
Please see the chart below for details about these types of plans.
Health Maintenance Organization
Preferred Provider Organization
Point of Service
|Annual Deductible||No, most plans||Yes, most plans||No, for in-network coverage on most plans|
|Set Copayment Amounts||Yes||No||Yes, for in-network coverage|
|Coinsurance||Yes, some plans||Yes||Yes, for out-of-network coverage|
|Out-of-Network Coverage||Emergent care only||Yes||Yes|
|Primary Care Physician Required||Yes||No||Yes|
|Chiropractic Care or Spinal Manipulation Included||***Yes, QHP plans||Yes||***Yes, QHP plans|
|Individual and Family Coverage||Yes||****Yes||****Yes|
|Preventive Care||No charge||No charge (in-network only)||No charge (in-network only)|
|Health Savings Account (HSA)||Yes||Yes||Yes|
|Health Reimbursement Arrangement (HRA)||Yes||Yes||Yes|
|Flexible Spending Account (FSA)**||Yes||Yes||Yes|
*Optima Health does not require referrals for HMO plans; however other insurance carriers may require a referral for specialist treatment.
**Flexible Spending Accounts are generally offered by an employer and are not specifically tied to a health plan.
***Spinal manipulation is covered under all Affordable Care Act-compliant qualified health plans (QHP).
****Optima Health does not currently offer Individual & Family PPO or POS plans.
Funding Options for Consumer Driven Plans
Health Savings Account
Flexible Spending Account
Health Reimbursement Account
|Who Contributes?||Employee and/or Employer||Employee||Employee and/or Employer|
|Uses||Qualified medical expenses||Qualified medical expenses||Qualified medical expenses|
|Unused Funds at End of Year||Roll over to next year||Use it or lose it||Given back to employer|