Types of Managed Care Insurance
Health Maintenance Organization (HMO)
- HMOs offer members a range of health benefits, including preventive care, for a set monthly fee.
- With some HMOs, you will pay nothing when you visit doctors; with others there may be a copayment for various services.
- An HMO plan usually covers only the cost of charges for doctors in that HMO. If you go outside the HMO, you will pay the bill.
- Generally, with an HMO, a patient will select a primary care doctor who will coordinate their care, including referring them to a specialist.
Preferred Provider Organization (PPO)
- A PPO has arrangements with doctors, hospitals and other providers of care who have agreed to accept predetermined fees from the insurer for their services.
- If you go to a doctor within the PPO network, you will pay a copayment (a set amount you pay for certain services-for example, $15 for a doctor or $10 for a prescription).
- If you go outside the PP0 network, you will have to meet the deductible and pay coinsurance based on in higher charges. You may also have to pay the difference between what the provider charges and what the plan will pay.
Point-of-Service (P0S) Plan
- Many HMOs offer an indemnity-type option known as a POS plan.
- In a POS plan, there are primary care doctors who make referrals to other providers in the plan. If the doctor makes a referral out of the network, the plan pays all or most of the bill.
- But, generally in a POS plan, members can refer themselves outside the plan and still get some coverage.
Check with your insurer regarding coverages and copayments.
Accepted Insurance Carriers
|Carrier||Type Of Plan|
|Aetna||EPO / POS / PPO|
|Blue Cross Blue Shield of North Carolina
|Blue Cross Blue Shield of South Carolina
|Capp Care (under Beech Street)||PPO|
|Carolina Care Plan (formerly Physicians Health Plan)||EPO / POS / PPO|
|CIGNA||PPO / POS / HMO / Flex Care|
|Southcare (formerly Ethix PPO)||PPO|
|Health Care Savings||Other|
||PPO / HMO / POS|
|HealthSource||HMO / POS|
|PPO Next / Healthstar / HealthMark / PHN PPO||PPO / EPO|
|Kanawha Preferred Solutions
||PPO / EPO / POS / HMO|
|MPI/Southern Fine Banking||PPO|
|One Health Plan||PPO / POS|
|CCN/One Source (formerly THAN)||PPO|
|Opitmum Health Plan PPO for St Francis Employees||PPO|
|Partners HMO of NC||HMO|
||PPO / POS|
|Physicians Care Network||Other|
|Premier Health Systems||PPO|
||PPO / POS|
|Prudential Healthcare PPO||PPO|
|Rutherford Health Plan||PPO|
|Synthetic Industries, Inc.||PPO|
|Unicare Life & Health/Metromont||PPO|