Directions: Now that you understand the basic terminology and the plans, we will look at three sample policies for one company and compare what it offers. Use what you have learned about each type of plan and the health plan documents in the Study Section of this lesson complete the chart and answer the questions Ruth, Daniel, and David. Use the Health Plan Comparison Chart to record your answers. Individual Name Ruth Daniel David Plan Type HMO 10 PPO PCHS Providers POS Primary Care Required Yes or No Referral Required for Specialist Yes or No Office Visit In Network Office Visit Out of Network Deductible In Network Physical Therapy Out of Network Generic Prescription Home Health Care Emergency Room Outpatient Surgery Speech Therapy 1. Which Plan would you choose? Why? 2. What did you learn that was surprising? HMO- HEALTH MAINTENANCE ORGANIZATION Provides health benefits through a network which requires a primary care physician for your regular doctor's visits. It requires a referral for specialists, such as a dermatologist, from your primary care physician. Provides health benefits through a network of physicians but still allows you to see others out of the network for higher costs. It does not require the selection of a primary care physician or a referral for a specialist. a PPO - PREFERRED PROVIDER ORGANIZATION POS POINT OF SALE This plan combines the options of the HMO and PPO by allowing the individual to have low co-pay and choose a physician in or out of network. Directions: Now that you understand the basic terminology and the plans, we will look at three sample policies for one company and compare what it offers. Use what you have learned about each type of plan and the health plan documents in the Study Section of this lesson complete the chart and answer the questions Ruth, Daniel, and David. Use the Health Plan Comparison Chart to record your answers. Individual Name Ruth Daniel David Plan Type HMO 10 PPO PCHS Providers POS Primary Care Required Yes or No Referral Required for Specialist Yes or No Office Visit In Network Office Visit Out of Network Deductible In Network Physical Therapy Out of Network Generic Prescription Home Health Care Emergency Room Outpatient Surgery Speech Therapy 1. Which Plan would you choose? Why? 2. What did you learn that was surprising? HMO- HEALTH MAINTENANCE ORGANIZATION Provides health benefits through a network which requires a primary care physician for your regular doctor's visits. It requires a referral for specialists, such as a dermatologist, from your primary care physician. Provides health benefits through a network of physicians but still allows you to see others out of the network for higher costs. It does not require the selection of a primary care physician or a referral for a specialist. a PPO - PREFERRED PROVIDER ORGANIZATION POS POINT OF SALE This plan combines the options of the HMO and PPO by allowing the individual to have low co-pay and choose a physician in or out of network