Here are more details about HMO plans:. In HMOs, providers or doctors either work for the HMO or contract for set rates as opposed to being paid per service they perform. Out-of-network care is allowed in emergency cases only. This PCP is your main health care contact. Your care is often coordinated through them. You may even need to get a referral from them to see a specialist. You may need to get advanced approval before having certain medical services performed, but in an HMO, in many cases that preapproval will be handled through your PCP, if you have one.
PCP stands for primary care physician or provider. In a network, this is usually a doctor who practices internal medicine, family or general practice, or pediatrics. This PCP coordinates the majority of your medical care in the network, handling physicals, routine illnesses, preventive care and so on. Your PCP will also arrange referrals to specialists or preapprovals for certain medical services when needed.
Want to see someone in-network? Want to see someone out-of-network? Premiums tend to be higher with this type of plan, which is commonly often paired with a deductible. Here are more details about PPO plans:. Similar to an EPO, a PPO network is made up of those doctors and facilities that have negotiated lower rates on the services they perform.
PPO health plans have access to those negotiated rates. You may have lower out-of-pocket costs from the PPO provider than you would out-of-network. However, PPOs do vary, so be sure to check the network requirements before you apply. Almost every network requires preapprovals for some medical services, and in a PPO, because you have more freedom to choose where to go and who to see, you may face more preapprovals. In some networks, preapprovals are required for some services or procedures.
Without preapproval, that service may be covered less or not at all. Preapprovals are sometimes called prior authorizations. On the flip side, there are no out-of-network benefits. Here are more details about EPO plans:. Doctors and facilities that participate in an EPO are paid per service.
Instead they have negotiated lower rates on services they perform for members of the EPO health plan. Generally, you can get care from any provider if you stay in-network. The HSA helps pay his medical bills. Myron is feeling confident that he and Joseph will soon be planning their next trip. Ready to test out your newfound knowledge? Take our quiz , and see how you do!
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Each main plan type has more than one subtype. Some subtypes have five tiers of coverage. Others have four tiers, three tiers or two tiers.
This search will use the five-tier subtype. It will show you whether a drug is covered or not covered, but the tier information may not be the same as it is for your specific plan. Do you want to continue? Individuals overview. Get a quote. Medicare Health insurance Dental coverage Vision insurance Medicaid. General plan info. Medicare Plans through an employer Medicaid Student health plans International plans.
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Producer World. About us. If you use an out-of-network doctor, you are responsible for making the arrangements. Your plan materials will identify which procedures require pre-certification. Some plans may also provide out-of-network coverage for certain Urgent Care Services.
See your plan documents for the details of your specific medical plan. Louis, Inc. Plans contain exclusions and limitations and may not be available in all areas. For costs and details of coverage, review your plan materials. All insurance policies and group benefit plans contain exclusions and limitations. For availability, costs and complete details of coverage, contact a licensed agent or Cigna sales representative.
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