HMO Health Maintenance Organizations

1
Some Definitions

• HMO Health Maintenance Organizations
• These Organizations provide health care plans
  that are serviced by their network of clinics and
  doctors. These organizations require selection of
  a Primary Care Physician (PCP) and their services
  are usually paid in full after the initial
  required copayment. The provider receives a fixed
  amount of money regardless of the number of
  patients seen.
• PCA Personal Care Account
• In the new Definity Health care plan, Stanford
  creates this account of benefit dollars for the
  employee. This account covers the first cost
  dollar payment towards health care expenses and
  is used towards the deductible unused benefits
  dollars roll over to the next year.
• PCP Primary Care Physician
• A PCP is your personal physician who provides,
  authorizes and/or coordinates your medical
  services within an HMO. This person is your main
  doctor.
• POS Point of Service
• This type of plan combines the cost savings of
  an HMO with the flexibility of a PPO. You only
  pay a copay when you see your doctor you can use
  out-of-network providers but out-of-pocket costs
  will be more.
• PPO Preferred Provider Network
• Higher level of benefits as long as care is
  provided within a contracted network of
  providers. Network providers agree to accept a
  lower negotiated rate for services. Care received
  outside this network is reimbursed at a lower
  rate. Providers get paid on a fee for service
  basis.
• Consumer Driven Plans
• Health plans designed to help control cost by
  allowing the consumers to take greater
  responsibility by directly managing their own
  benefit dollars when paying for health services
  Consumer driven model.
• Managed Care Plans