Group & Individual Medical Insurance (HMO, PPO, POS & traditional indemnity, comprehensive and emergency):

An insurance policy that protects the insured in case of illness or injury, and that pays for the appropriate medical treatments required, based upon limits established within the individual policies.

HMO - Health Maintenance Organization:

A primary care physician (PCP), who will be compensated by the insurance company, must be selected from the designated network at the time of enrollment. The selected PCP will manage all care provided to the insured. In order to see a contracted specialist or receive services from a hospital, a referral must first be obtained from the PCP, except in cases of life-threatening emergencies. No benefits are provided if the insured goes out of the network. There are minimal to no co-payments, no annual deductibles, and no claim forms.

HMO Advantages: One monthly payment covers all of your medical expenses. You will only see one co-payment amount per visit regardless of the care you've been provided. You will always know your medical costs up-front. The doctors are all prescreened, and no paperwork is required.

HMO Disadvantages: Limited in choices (participation vs. non-participation), with more out-of -pocket for outside care. More difficult to see necessary specialist if the doctor does not give consent.

PPO - Preferred Provider Organization: A managed-care system in which the insured can choose from a network of healthcare providers for medical attention, or the insured can go outside the group. A discounted fee is available for insured's whom use the listed healthcare providers. PPO plans are similar to an indemnity plan, but with a network of physicians. The insured is allowed to choose a doctor or hospital from a preferred-provider list. Preferred providers are doctors, hospitals, and other non-network providers. They have agreed to group pricing and will follow the procedures and policies of the plan. Lower fees are arranged with the network of providers, giving insured's a financial incentive to stay within the network. A higher cost or co-pay is generally required for medical services obtained from outside sources.

PPO Advantages: You are responsible to turn in the paperwork.

PPO Disadvantages: More flexible than an HMO because you can choose or limit medical costs by using in-network doctors. However, you don't know your true costs in advance as you would in an indemnity plan.

POS - Point-of-Service: Healthcare delivery method offered as an option of an employer's indemnity program in which employees coordinate their healthcare needs through a primary-care physician. Similar to an HMO, this healthcare delivery method requires selecting a primary-care physician (PCP), who coordinates the insured's healthcare needs.

EPO - Exclusive Provider Organization: Any physician within the contracted network can be visited without prior approval or referrals. Services received outside the network, however, generally are not covered.