Managed Care Plan

Managed Care Plan

Introduction

This paper deals with the comparison and contrast between of two insurance companies that offer managed care plans, which includes Health Maintenance Organization, Point of Service and Preferred Provider Organization. In order to compare the insurance companies on this basis, we first need to have a basic understanding of these components of managed care plan.

Managed care plans

Managed care plans include HMO, which is a part of insurance company that has contracts with doctors, hospitals, employers, and provides coverage for individual health insurance in exchange for a fixed fee or premium. The entity must prefer a primary care physician within the HMO system, through which all decisions will be made ??on health care which includes prescription, admitting to the hospital, transfers to specialists, and other medical tests.

Secondly, the point of service plan, which is commonly known as POS, is a type of management plan of care that combines HMO and PPO plans. Like an HMO, members designate a physician within the network as their primary care provider. But like a PPO, members can go outside the network of providers for health services. When members leave the network have to pay most of the costs, unless the primary care provider has referred to non-network provider. Then the health plan will pay the bill.

Another major component of managed care plan is t he PPO Benefit Plan or Preferred Provider Organization. It is a plan that has an agreement with doctors and hospitals to ensure preferred rates for you and your family members which are covered. One may decide to visit a PPO provider whenever they need care. If we choose a provider that is not within the PPO, we can for apply lower level of benefits. While choosing a PPO provider, the applicant usually receives quality medical care and a high level of ...