State of California California Department of Consumer Affairs

Health Benefits Program (Types)

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HEALTH BENEFITS PROGRAM (TYPES)

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Managed care health plans generally fall into three categories as follows:


Health Maintenance Organization (HMO)

Members are restricted to seeing HMO physicians. Usually, doctor visits outside the plan are not covered. The patient's primary physician will control patient access to specialists. Doctors may be employed by the HMO or practice independently. HMO's are regulated by the Department of Managed Health Care.



Point-of-Service (POS)

A Preferred Provider Organization is basically a group of doctors who negotiate discounts with insurers. Unlike HMO's, there may be no restrictions on seeing specialists; however, members pay higher costs if they see non-PPO physicians. These plans are regulated by the Department of Insurance.



Preferred Provider Organization (PPO)

A Preferred Provider Organization is basically a group of doctors who negotiate discounts with insurers. Unlike HMOs, there may be no restrictions on seeing specialists; however, members pay higher costs if they see non-PPO physicians. These plans are regulated by the Department of Insurance.




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