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  • Will You Add? - Every Thing You Need to Know About Individual Health Insurance Plans (Part II)

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    the PCP must initiate a referral.

    The disadvantage of an HMO is that participants are forced to choose a PCP from the HMOs approved list of providers and sometimes, their 'preferred' doctor is not on the list. The HMO typ

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    In “Every Thing You Need to Know about Individual Health Insurance Plans (Part I)”, we began our discussion of individual health insurance plans by talking about indemnity plans. We then started a discussion about managed health care plans. We now continue that discussion…

    A Health Maintenance Organization (HMO) plan is less expensive than a PPO and generally includes coverage for preventative care. Participants are required to pay a monthly premium, and a nominal co-payment each time they see a doctor. They must be seen by medical care providers that are part of the HMO network. These medical care providers have an agreement with the insurance company to perform various medical procedures at a previously negotiated and reduced rate. Participants are required to select from this group of providers a Primary Care Physician (PCP) and must always see their PCP first. To be seen by a specialist, the PCP must initiate a referral.

    The disadvantage of an HMO is that participants are forced to choose a PCP from the HMOs approved list of providers and sometimes, their 'preferred' doctor is not on the list. The HMO typi

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    A Health Maintenance Organization (HMO) plan is less expensive than a PPO and generally includes coverage for preventative care. Participants are required to pay a monthly premium, and a nominal co-payment each time they see a doctor. They must be seen by medical care providers that are part of the HMO network. These medical care providers have an agreement with the insurance company to perform various medical procedures at a previously negotiated and reduced rate. Participants are required to select from this group of providers a Primary Care Physician (PCP) and must always see their PCP first. To be seen by a specialist, the PCP must initiate a referral.

    The disadvantage of an HMO is that participants are forced to choose a PCP from the HMOs approved list of providers and sometimes, their 'preferred' doctor is not on the list. The HMO typ

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    emium, and a nominal co-payment each time they see a doctor. They must be seen by medical care providers that are part of the HMO network. These medical care providers have an agreement with the insurance company to perform various medical procedures at a previously negotiated and reduced rate. Participants are required to select from this group of providers a Primary Care Physician (PCP) and must always see their PCP first. To be seen by a specialist, the PCP must initiate a referral.

    The disadvantage of an HMO is that participants are forced to choose a PCP from the HMOs approved list of providers and sometimes, their 'preferred' doctor is not on the list. The HMO typ

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    ous medical procedures at a previously negotiated and reduced rate. Participants are required to select from this group of providers a Primary Care Physician (PCP) and must always see their PCP first. To be seen by a specialist, the PCP must initiate a referral.

    The disadvantage of an HMO is that participants are forced to choose a PCP from the HMOs approved list of providers and sometimes, their 'preferred' doctor is not on the list. The HMO typ

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    the PCP must initiate a referral.

    The disadvantage of an HMO is that participants are forced to choose a PCP from the HMOs approved list of providers and sometimes, their 'preferred' doctor is not on the list. The HMO typically won't cover the costs of medical care provided by professionals outside the HMO network. And because an HMO network is limited in size, it often takes a long time to get an appointment with the PCP.

    A Preferred Provider Organizations (PPO) is similar to a HMO, except that there is no need to first be seen by a PCP. Participants are advised to choose a medical professional from the PPO's approved 'network' but they don't have to and they don't need a referral to see a specialist. Should a participant choose to go outside the network, their co-payment will generally be higher, the percentage that the PPO pays for the medical care will be lower, and they will likely have to satisfy a deductible. PPO plans have become the most popular individual health insurance plan in the U.S. today. Although PPOs offer more freedom of choice, there are generally more costs involved in this type of manage

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