The Complete Guide To Healthcare Insurance Plans & Network Types | PPOs, EPOs, & More.

published on 14 April 2021
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There are many kinds of healthcare plans and networks in the marketplace today. While some of these plans allow you to choose the healthcare providers, doctors, or pharmacies freely, other healthcare plans restrict you. 

Knowing the type of network your healthcare plan has is very relevant when choosing a plan. In this article, we will be sharing with you some basic information pertaining to these plans and networks. 

What is the provider network in health insurance? 

In simple words, a provider network is the set of doctors, hospitals, pharmacies, and other healthcare providers and facilities that have a contract with the medical insurance companies. This list of service providers is called the Provider Network. 

Different Types of healthcare insurance plans and networks 

There are different tiers of health insurance policies all over the world today. This categorization, however, is done on the basis of the cost of the plan. Another categorization of these plans can also be done on the basis of the network which includes the following:

  • EPO (Exclusive Provider Organization) 
  • HMO (Health Maintenance Organization) 
  • POS (Point of Service) 
  • PPO (Preferred Provider Organization) 

EPO (Exclusive Provider Organization) - This is the health insurance plan that will provide the health insurance cover only if you use the services in their network including the doctors, pharmacies, and even hospitals. 

HMO (Health Maintenance Organization) - This is the health insurance plan in which you will get limited coverage to care from the network of doctors who work in contract with the HMO. It usually does not include the out of network health coverage. Apart from this, most of the HMOs are also available only for the people who live or work in its service area. 

POS (Point of Service) - This is the type of healthcare plan or network in which you pay less for the services if you take them from your insurance providers’ network of doctors, hospitals, and other health care facilities. However, in POS you have to first get the referral from your primary doctor in case you need a specialist. 

PPO (Preferred Provider Organization) - This is the type of healthcare insurance plan in which you are allowed to choose the healthcare service providers outside of their network without any referral for an additional cost. Remember, in this plan as well, if you go with the service providers, doctors, pharmacies, etc available in their network, you will be charged less. 

Conclusion 

We hope that you got all the information regarding different types of healthcare insurance plans and networks. Make sure that you check the type of network before buying the health insurance. Also, if you are confused about which plan to choose between individual and family plan, here is the guide for selecting between individual and family plans.

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