Health care organisations help people in need of health care gain access to it at minimal costs. These organisations offer economic incentives for physicians and patients to select forms of treatment and care that have lower costs while still maintaining quality. By incentivising this type of behaviour, health care organisations broaden the availability of basic medical necessities.
A Health Maintenance Organization (HMO) is a type of organisation that includes several hospitals, physicians and insurance plans that work together to offer services under similar rules and regulations. As a member of an HMO, you pay monthly premiums and the HMO offers you the medical services you and your family might need, such as doctor visits, emergency care, hospital stays, surgery, X-rays, laboratory tests and therapy. However, your choices of doctors and hospitals are limited to those providers who have agreements with the HMO, and sometimes you might even get assigned to a specific doctor and hospital. The coverage of services depends on the type of HMO plan you choose. Some HMOs have physicians that work for a salary at an HMO building, which you can utilise if you live in the area. Investigate your local HMO thoroughly to ascertain its quality before you enrol.
A Preferred Provider Organization (PPO) is a health organisation that consists of a network of physicians and hospitals. For this reason, your choices of medical care, such as a doctor, are limited. However, with PPOs, you can choose an outside provider, but your benefits in this case will be lower, and you will have to pay more from your pocket. PPO providers use member cards to identify their clients, and that is all you need to present when you go to see a doctor. Though PPOs cover the bulk of the costs, they may ask you to make a small co-payment and deductible for your visit. The basic coverage of a PPO is preventive care such as doctor visits and baby care. However, other coverages will depend on which PPO you choose to join.
A Point-of-Service plan (POS) is a type of health care organisation that unites characteristics of an HMO and a PPO. POS plans are composed of different providers who offer health care solutions at lower prices. Your choice of providers is somewhat limited, though, since you must choose from a list that your POS gives to you. However, if you have the need for a specialist, you can see out-of-network providers. You do not need to worry about paperwork when visiting POS network providers, but when you visit out-of-network providers, you need to submit claims to your POS company yourself. As with the other organisations already mentioned, if you use doctors that are not included in the POS network, you will have to pay more out of your pocket for that visit than you would have paid to see a member provider. POS plans focus on health prevention and education, but other services are also offered, depending on the type of plan you choose.
- Jupiterimages/Photos.com/Getty Images