Page 325 - Ebook health insurance IC27

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Preferred Provider Organization (PPO)
Networks of providers with which contracts are negotiated for clients to receive medical
services at discounted costs.

Health Maintenance Organization (HMO)
Prepaid health plans in which members pay monthly premium and the HMO covers
doctors' visits, hospital stays, emergency care, surgery, preventive care, checkups, lab
tests, X-rays, and therapy. Under these arrangements, each member must choose a
primary care physician who coordinates the entire member's' need for services and
makes referrals to specialists if required.

Point-of-Service (POS) Plan
A type of managed care plan combining features of HMO's and PPO's, in which members
decide whether to go to a network provider and pay a flat amount per visit as a co-
payment, or to an out-of-network provider and pay a deductible and/or a coinsurance
charge.

Managed care schemes are widely used in the US. Application of pure managed care in
the Indian sub continent is limited. Some insurance companies, especially in Saudi Arabia
sell Capitation Contracts and in UAE they have started offering HMO products.

Hospital cash plans
These plans provide fixed daily cash sums during hospitalizations, irrespective of the
cost of the treatment. The cash sums are partial compensation for hospitalization expenses
and consequent loss of earnings.

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