Question:
please explain the difference between all the differnet types of ins.(mco,ppo,hmo,etc

   — MFUQUA123 (posted on December 29, 2005)

December 29, 2005
HMOs-health maintenance organizations typically consist of a network of providers/hospitals that you must go to to receive maximum benefits from your insurance. Typically with an HMO if you go out of network there is no medical coverage/benefit. PPOS can be referred to as either a preferred provider organization or I have seen some employers refer to them as a participating provider organization. These plans are a type of morphed version of an HMO in combination with a traditional indemnity plan. Many employers have changed their definitions of how they operate. PPOs 'typically' have a financial incentive to drive you to use a preferred provider in a network to receive the greatest medical coverage/benefit. The difference from a PPO to a HMO is that there is usually a level of coverage still available if you go out of network...sometimes it's a lower reimbursement like 70% versus 100%. These are just some typical definitions of how these plans work. I train people on health care benefits and the plan definitions are so different from company to company. It's best to call your employer's customer service/call center for medical coverage information to get specifics on your/a plan design. Ask for a copy of either the summmary plan description for the medical plan or medical plan highlights. Hope this helps.
   — Lisa D