Group Medical

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HMO

 A traditional "gatekeeper" model Health Maintenance Organization (HMO) plan requires members to select a Primary Care Physician. Referrals to participating specialists, fully-integrated medical management, and comprehensive benefits are subject to small co-payments. There are no out-of-network benefits.  

Direct Access HMO

This plan is the same as the HMO plan described above, except there are no referrals to participating specialists. Again, there is no coverage outside the network.  

Point Of Service

The Point-of-Service (POS) plan is the same as the HMO plan described above. But it gives members the option of using non-participating providers subject to a lesser benefit with additional out-of-pocket costs (deductibles and coinsurance).  

Direct Access Point Of Service

The Direct Access POS is a plan that allows members to see any participating specialist without needing a referral from their Primary Care Physician. In addition, it offers members the option of accessing care outside of the network subject to a lesser benefit. 

Preferred Provider Organization

The Preferred Provider Organization (PPO) is a "non-gatekeeper" network-based health insurance. Members do not select a Primary Care Physician. Referrals are not required. Members may access participating or non-participating providers.  

Exclusive Provider Organization

Exclusive Provider Organization (EPO) can be described as an HMO with no "gatekeeper" or referrals. It is a health insurance plan with a select network of participating providers (usually different from the HMO network). The member must obtain all services from this organization.