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Different Types of Health Plans

Health Maintenance Organizations (HMOs)

Health Maintenance Organizations are prepaid health plans in which individuals or employers pay a monthly premium. In exchange, the HMO provides comprehensive care for you and your family, including doctor visits, hospital stays, emergency care, surgery, lab tests, x-rays and therapy.

Except in an emergency, HMOs usually do not pay anything toward your care if you do not use the plan's network providers.

Members generally must make a copayment for services and use doctors in the network. Out-of-pocket costs are likely to be lower and more predictable than in an indemnity or fee-for-service plan.

Point-of-Service (POS)

A POS plan, also known as an open-ended HMO, is a blend of HMO and PPO coverage. You may use doctors in the HMO network or you may choose other doctors. You pay a higher cost if you use doctors outside the network.

Preferred Provider Organization (PPO)

Preferred Provider Organization is a plan that contracts with independent providers at a discount for services. The enrollees may go outside the network, but would pay a greater percentage of the cost of coverage than within the network.

Traditional health insurance

Under traditional major medical insurance, you are covered to use any hospital or doctor. Traditional insurance plans normally require you to pay a monthly premium, an annual deductible and coinsurance for each service.

Coverage provided by employers

Most Ohioans get health insurance coverage through their employers. It is important to understand, however, that employers offer insurance voluntarily -- no law requires it.

The employer may offer insurance that covers you only, or may offer coverage to you and your dependents. Plan coverage details may be based on whether you are part of a large or small employer group.

Some large employers "self-insure" the health benefit plans that cover employees. If your employer is self-insured, it means the employer, not an insurance company, is responsible for payment of your covered health care services.

These plans may be administered by the employer itself or the employer may contract with an outside administrator (often a health insurance company) to process claims. The best way to know if your plan is self-insured is to ask your employer's Human Resources department.

Many self-insured plans are not subject to state insurance laws. The U.S. Department of Labor regulates most aspects of self-insured health plans under the Employees Retirement Income Security Act (ERISA). Call 1-866-487-2365.

Health Savings Account (HSA) with a high-deductible health plan

Employers may offer Health Savings Accounts to employees. HSAs are savings funds that allow you to pay some health care costs with tax-free dollars. HSAs let you pay for current medical expenses and save for future qualified medical and retiree health expenses on a tax-free basis.

In order to use a health savings account you must purchase a high-deductible health plan to use with it. Under a high-deductible health plan, you pay a lower premium and accept greater risk.

Professional organization plans and association plans

Sometimes associations such as local chambers of commerce and professional organizations offer group health plans. You may also qualify for health insurance through a religious or fraternal organization.