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Types of Managed Care Insurance
Health Maintenance Organization
(HMO)
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HMOs offer members a range of health benefits,
including preventive care, for a set monthly fee.
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With some HMOs, you will pay nothing when you
visit doctors; with others there may be a copayment
for various services.
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An HMO plan usually covers only the cost
of
charges for doctors in that HMO. If you go outside
the HMO, you will pay the bill.
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Generally, with an HMO, a patient will select a
primary care doctor who will coordinate their care,
including referring them to a specialist.
Preferred Provider Organization (PPO)
A PPO has arrangements with doctors, hospitals
and other providers of care who have agreed to
accept predetermined fees from the insurer for
their services.
If you go to a doctor within the PPO network, you
will pay a copayment (a set amount you pay for certain services-for example, $15 for a doctor or $10
for a prescription).
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If you go outside the PP0 network, you will have to
meet the deductible and pay coinsurance based on in
higher charges. You may also have to pay the difference between what the provider charges and
what the plan will pay.
Point-of-Service (P0S) Plan
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Many HMOs offer an indemnity-type option
known
as a POS plan.
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In a POS plan, there are primary care doctors who
make referrals to other providers in the plan. If the
doctor makes a referral out of the network, the
plan
pays all or most of the bill.
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But, generally in a POS plan, members
can refer them
selves outside the plan and still get some coverage.
Check with your insurer regarding coverages and copayments.
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Accepted Insurance Carriers
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Carrier
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Type Of Plan |
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EPO/POS/PPO
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Beech Street |
PPO |
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Blue Cross Blue Shield of North Carolina
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Costwise
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MedPoint
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Preferred Care Select
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Blue Cross Blue Shield of South Carolina
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Capp Care ( under Beech Street) |
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Carolina Care Plan (formerly Physicians Health Plan) |
EPO/POS/PPO |
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CIGNA |
PPO/POS/HMO/Flex Care |
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Crescent |
PPO |
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Southcare (formerly Ethix PPO) |
PPO |
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Evolutions Healthcare |
PPO |
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Hamrick’s |
PPO |
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Health Care Savings |
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Healthfirst “Options”
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Preferred PPO
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Signature HMO
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Options POS
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PPO/HMO/POS
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HealthSource |
HMO/POS |
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PPO Next/ Healthstar/ HealthMark/PHN PPO |
PPO/EPO |
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Inman Mills/ACMG |
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Kanawha Preferred Solutions
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PPO/EPO/POS/HMO
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KEBA
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MedCost
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PPO |
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Medicaid |
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Medicare |
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MPI/Southern Fine Banking |
PPO |
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One Health Plan |
PPO/POS |
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CCN/One Source formerly THAN |
PPO |
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Opitmum Health Plan PPO for St Francis Employess |
PPO |
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Patient First |
PPO |
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Partners HMO of NC |
HMO |
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PHCS
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PPO/POS |
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Physicians Care Network |
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Premier Health Systems |
PPO |
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Provident/Healthsource
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Preferred Network (PPO)
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Point of Service (POS)
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PPO, POS |
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Prudential Healthcare PPO |
PPO |
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Rutherford Health Plan |
PPO |
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Spartanburg Advantage |
PPO |
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Sunbelt Container/Tim-Bar |
PPO |
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Synthetic Industries, Inc. |
PPO |
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Unicare Life & Health/Metromont |
PPO |
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WellPath |
HMO |
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Regional Select
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