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Different Types of Kentucky Health Insurance

Kentucky Department of Insurance: Facts about Health Insurance

There are several types of health insurance policies in Kentucky, which are listed below. Each plan provides services differently. You need to understand your plan and know how it works.

• Traditional Fee-for-Service (FFS) plans allow an individual to go to the doctor of his or her choice and then submit the claim.
• Health Maintenance Organization (HMO) plans provide services through a network of doctors, hospitals, laboratories and other providers. When you enroll in an HMO, you may be required to select one doctor as your primary care physician (PCP) to manage all your health care needs. You must contact that doctor first regardless of the type of care you need. Your physician will then refer you to an HMO-approved specialist for additional care, if necessary.
• Preferred Provider Organization (PPO) is a group of doctors, hospitals and other providers who have agreed to provide services to members of a health plan. However, benefits also are available when you use providers who are not on the PPO list. To encourage use of the preferred providers, they charge lower out-of pocket expenses than if you use a provider not on the list.
• Point of Service (POS) is similar to an HMO in that you select a primary care physician (PCP) to manage care and give referrals to network providers. A POS also gives the option to see a provider outside the network. However, if you leave the network, the plan pays at a reduced rate and you will have more out-of-pocket expenses.