top What are the major types of managed care plans?
• Health Maintenance Organizations (HMO) • Preferred Provider Organizations (PPO) • Point-of-Service (POS) plans Each of these systems has distinctive features or characteristics. top Health Maintenance Organizations (HMO) An HMO enters into contractual arrangements with healthcare providers (e.g., physicians, hospitals and other healthcare professionals) who together form a “provider network.” In simple terms, a contracted provider is one who provides services to health plan members at discounted rates in exchange for receiving health plan referrals. Members are required to see only providers within this network to have their healthcare paid for by the HMO. If the member receives care from a provider who isn’t in the network, the HMO won’t pay for care unless it was pre-authorized by the HMO or deemed an emergency.
