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PPO:
Preferred Provider Organization. A group of health care providers
working together as a network of providers to provider discounts for
services.
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Non-PPO:
Non-Preferred, not within the PPO Network. These providers do not participate
in a PPO Network to control or reduce costs.
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Deductible:
An amount of money paid usually annually by the insured, directly
to a health care provider before insurance benefits are payable.
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Co-insurance:
The portions or percentages you and the insurance carrier share in of the
total incurred charges.
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Out-of-pocket:
This is an amount the insured must pay each year before eligible benefits
are payable at 100% for the remainder of the calendar year. This amount
is to be satisfied on an individual and/or family basis.
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HMO:
Health Maintenance Organization. Another group of providers working
exclusively together as a network. All services must be performed
by the participating providers otherwise no benefits are payable or
eligible.
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PCP:
Primary Care Physician. This provider is selected by the insured when
enrolling with an HMO Plan. This provider manages and directs your
health care. All services and care MUST be authorized by him/her.
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POS:
Point Of Service. POS is a blend of a PPO and HMO Plan designs. Meaning,
if a POS Provider is used, the benefits "look like" an HMO plan. However,
if a Non-POS provider is used, then benefits are paid at a lower co-insurance
but are eligible for payment as in PPO Plan at either the Network
or Non-Network benefit level.
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Co-pay:
An amount of money paid by the insured at the time services are rendered
for office visits, prescription drugs, etc.
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Provider directory:
A listing of the participating providers within
a network. Separated by PPO, HMO and POS providers. These directories
vary by each insurance company and each insurance company has their
own network. The documents are obtained via the internet at each
insurance company's web-site or in a paper book/catalog.
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