The type of health plan you join can affect what is covered, what you pay, and the doctors and hospitals you can use. The big difference in types of health plans is whether they have a network: the group of doctors, hospitals, and other health care providers who serve people in a specific health plan.

NETWORK | Health Maintenance Organization | Point Of Service option | Preferred Provider Organization | Traditional type of insurance

If you are in a health plan with a network, to pay the least and get the most benefits and coverage, you have to use the doctors, hospitals, and other providers in the network. Networks have providers who have met standards set by the health plans.

Most HMOs ask you to choose a doctor or clinic to be your primary care provider, or PCP. Your PCP takes care of most of your medical needs.

In many HMOs, in order to see a specialist or other providers in the network, you must talk to your PCP to get approval for a "referral." Women have direct access to an obstetrician/gynecologist for their reproductive or gynecological care.

Points to consider:

• More health care services may be covered that are not usually covered by traditional insurance, such as preventive care.
• Premiums and out of pocket cost are usually less.
• If you choose to see a doctor or other provider who is not in the network, you will have to pay the full cost.
• You will have very little paperwork.
• Premiums and out of pocket cost may be less.
• HMOs participate in quality improvement projects with physicians and hospitals.
• Providers' credentials are verified.

Points to consider:
If you use only a Provider who IS in the HMO network.

• You will pay less when you get care.
• You get full HMO benefits/coverage.
• You will have very little paperwork.

If you use a Provider who IS NOT in the HMO network:

• You will pay more when you get care.
• Fewer health services may be covered and some services may not be covered at all.
• You generally have to file a claim.
• Providers' credentials are verified.

Points to consider:
If you use a Provider who IS in the PPO network:

• You will pay less when you get care.
• More health care services may be covered.
• You may have less paperwork.

If you use a Provider who IS NOT in the PPO network:

• You will pay more when you get care.
• Fewer health care services may be covered.
• You generally have to file a claim.

This type lets you use any doctor or hospital, but usually cost you more.

These plans are called "fee-for-service" because doctors and other providers receive a fee for each service such as an office visit, test, procedure, or other health care service. There is usually a "deductible," which is the dollar amount you must pay each year before the insurance company begins to pay. And when your insurance does pay, you usually have to pay a portion of the cost yourself (for example, 20 percent of the charge.)

Points to consider:

• You will have no limitations on choice of providers.
• You may pay more when you get health care (office visits, hospital stays, etc.)
• There is more paperwork, such as filing claim forms to get payment for services covered by the insurance, and keeping track of payments toward the deductible.
• Preventive services may not be covered.
• Premiums and out-of-pocket costs may be more.
• Your insurer may or may not send reminders to you or provide special resources, such as special programs for people with a chronic illness.

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