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TYPES OF MANAGED-HEALTHCARE PLANS



By Christiene from Raleigh, NC on January 31, 2006
Category: HMOs - PPOs

<span>TYPES OF MANAGED-HEALTHCARE PLANS </span>
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<span>The Similarities and Differences Between HMOs, PPOs, and POS</span>

<span>Managed-Healthcare Plans</span> come in three different types with one primary objective, and that is, to deliver the most comprehensive healthcare package among its members at reduced costs.

<span>HEALTH MAINTENANCE ORGANIZATION</span> (HMO) is considered the flagship of managed-healthcare plans. It is often called “pure managed care” because it philosophizes what a true managed-healthcare is -- medical professionals and hospitals known as “medical providers” are pre-selected and approved through an accreditation process and pooled together to form a network or organization from which a member-patient can refer to for availment of medical services. It is “managed” healthcare, pure and simple.

<span>Dr. Paul Ellwood,</span> a renowned health analyst was the early proponent of the term, “<span>health maintenance organization.</span>” Basically, it operates as a prepaid health insurance – members pay premiums or prescribed fees either annually, semi-annually, quarterly or monthly for all their healthcare needs which may arise in the future or while paying for their plan.

Members-patients can only avail of services and benefits stipulated in the contract and only those medical professionals who have accreditation with the organization can render service. Not in consonance with these primary conditions, any medical service availed of may either be paid for by the member, non-reimbursable, and at higher cost.

To deter costly hospitalization, an HMO focuses on preventive healthcare which highlights early diagnosis for ailments. It operates on fixed-cost schedule of benefits.

On the other hand, a <span>Preferred-Provider-Organization</span> (PPO) operates like an HMO as to providing medical care at reduced costs. However, members are given leeway to choose their medical provider. Accredited providers remain as the least-costly option to the member-patient.

With a<span> Point of Service</span> plan (POS), employees are allowed to select their physicians. In case of treatment needing special care, the member sees a POS physician first. This is necessary for the member to maximize his plan availment.

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