How do Traditional Major Medical, HMO, and PPO plans differ?
A traditional Major Medical plan refers to an insurance policy
that allows you to be reimbursed for covered medical expenses
after certain conditions are met. One of the conditions is that
you pay a deductible. As a general rule, the higher the deductible,
the lower the premium cost. The advantage of Traditional Major Medical
plan is that you will be able to choose your doctor without
reference to an approved list provided by the insurance carrier.
An HMO (Health Maintenance Organization) is a managed care program.
You will be required to select a Primary Care Physician from an approved
list provided by the HMO. This physician will then direct all of your
medical treatment including referring you to a specialist. If you
fail to see your Primary Care Physician first (unless in an emergency
situation), your benefit will either be sharply reduced or totally
abolished. Normally, a HMO plan provides comprehensive medical care,
such as immunizations, and physical exams. The filing of claim forms
may also be omitted since your Primary Care Physician can claim the
expenses directly from the carrier.
A PPO plan (Preferred Provider Organization) combines elements of a
Major Medical plan with an HMO. You can either visit a doctor within
the preferred list or choose an out-of-network doctor or hospital.
However, an increase percentage of the cost will be charged to you
if you don't use the participating doctors.