Home You & your doctor Nutrition & exercise Medication & treatment Mind over matter Practical concerns Insurance Links Texas Children's IBD Center

Types of insurance plans

Main page What to look for in an insurance plan Important insurance questions Insurance terms Types of insurance plans Understanding COBRA

Today, most people are insured through one of three types of insurance programs: health maintenance organizations, preferred provider organizations and point-of-service.

Health maintenance organizations (HMOs) are one of the most common types of insurance. These plans cost less but limit your choices. With most HMOs you:

• Pay no deductible

• See an HMO-contracted physician with referral from your primary care physician who might also be HMO-contracted

or

• See an HMO-paid physician within an HMO facility without a referral

• Pay for any care outside of the HMO

A preferred provider organization (PPO) plan has more out-of-pocket expenses but gives you more freedom to choose your physician. With most PPO plans you:

• Pay a deductible

• Choose your physician or hospital from a list of preferred providers and pay a certain fee

or

• Choose another physician or hospital and pay a larger fee

A point-of-service (POS) plan is similar to an HMO, but you have benefits in and out of the network. With most POS plans you:

• Choose within the POS network of physicians and facilities and pay less

• Choose outside the POS network and pay more

You usually need a primary care physician to refer you to specialists (specialists inside the network cost less than outside) in a POS plan.

© 2005 Texas Children's Hospital
Terms of Use