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Major Medical Plans

Healthcare: Consumer-directed healthcare plans can reduce Major Medical renewal premiums by 30%.


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Major Medical Programs:

HMO
Health Maintenance Organization - the advantage, "low out-of-pocket expenses"
HMOs provide medical treatment on a pre-paid basis. A primary care physician must be chosen (PCP) who is the first contact for all medical care needs. The PCP must be consulted before a specialist can be referred. There is usually no lifetime maximum in an HMO. HMOs do not reimbusrse out-of-pocket expenses, except for emergencies occuring outside the HMO's treatment area.
PPO
Preferred Provider Organization Plan - the advantage, "free choice of healthcare provider"
A program which provides benefits up to a high limit for most types of medical expenses incurred. Once the deductible is met, the insurance company pays a percentage of the "usual and customary" charges for covered service. Generally, the company pays 80% of the charges and the covered employee pays 20%. Normally, this plan includes a co-pay for physician visits, no referral for specialists and out-of-network benefits, after meeting the out-of-network deductible.
POS
Point of Service Plan - the advantage, "Maximum Freedom"
Requires you to choose a PCP within the network with no deductible and minimal co-payment. The PCP is responsible for all referrals within the network and no referrals for out-of-network treatment. For out-of-network healthcare, there is usually a low deductible and your co-payment will be a substantial percentage of the physician charge (typically 30-40%).

Links to the websites of Major Medical Providers: