What is a Health Insurance Network?
A Health Insurance Network is a group of doctors, providers, and hospitals that contracts with a health insurance company to provide medical services for negotiated rates. There are many different Networks available and each may vary with each insurer and specific health insurance plan, but the biggest difference between Networks is the cost of the policy and where coverage is available.
PPO (Preferred Provider Organization)
A PPO is a health insurance organization that provides cost-sharing benefits if you visit health professionals or facilities that are within their Network. A PPO health insurance plan typically has higher premiums than plans with other Network Organizations because they provide the freedom to go to any medical provider you choose and still maintain coverage and you do not need a referral to visit a health care specialist such as a dermatologist or chiropractor. If you see a doctor outside of the specified PPO Network, your share of the costs will be higher but will still be able to use your health insurance.
HMO (Health Maintenance Organization)
An HMO organization will provide you with a local Network of participating doctors, hospitals, and health care professionals that you are required to choose from. These plans also require you to choose a Primary Care Provider (PCP) from within the Network and is your “home base” for medical care. Your PCP helps coordinate all of your care and will also need to provide you with referrals to see In-network specialists. As long as you stay within Network, the costs with an HMO plan are typically lower than other types of health plans.
EPO (Exclusive Provider Organization)
An EPO is a health care organization in which the health insurer will only provide cost-sharing coverage when you visit providers designated within the network. This means that if you visit a doctor or medical facility that is not within the specified network, you will be required to pay the full cost of services, as if you had no health insurance at all. The only exception to this is in the case of emergency. In the event of an emergency, if you are taken to an out-of-network hospital in an ambulance, you will still be able to take advantage of the cost-sharing benefit outlined in your health insurance policy as if you were In-network.
POS (Point of Service)
A POS health insurance plan requires you to visit your primary care physician to get a referral before being allowed to visit a specialist for medical services. POS plans combine the features of HMO and PPO plans but the provider Network is typically much smaller than a PPO plan and the costs for In-network care are typically lower and similar to an HMO plan.
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