Some Definitions You Might Find Handy:
|
| HMO |
Members receive medical services through contracted physicians and
hospitals. Nominal co-payments are paid for office visits,
prescriptions and other covered services. There is no waiting period for treatment of
pre-existing conditions on covered services. |
| PPO |
Members can choose to receive care through either a network or non-network
provider. If care is received through a network provider,
fees are based on a negotiated discounted basis. Unlike HMO's, PPO's do not require the
selection of a Primary Care Physician to direct care. Waiting periods may be required for
some services for pre-existing conditions. |
| IPA |
Individual Practice Association is a group of
physicians or other individual providers who practice in their own separate offices but
are part of a central administrator that oversees referrals and other issues regarding
HMO's. A medical group also provides referrals but the doctors are in partnership. |
| PCP |
Primary Care Physician. The HMO doctor who
coordinates all your health care and medical needs, including basic care, referrals to
specialists and hospitalization arrangements. |
| Co-Payment |
The amount of money the patient must pay for medical services. Sometimes called a deductible. |
| Stop-Loss |
The maximum amount of money that must be paid
by the patient for all services received within a specified
period, usually a calendar year. |
| Co-Insurance |
The percentage the patient must pay for medical services until s/he reaches the stop-loss limit. |
