Question to compare |
HMO |
HMO/POS Option |
Can I get services from providers who are out-of-network? |
No. The HMO pays for all covered services as long as you use in-network providers. If you go out-of-network, you pay the entire cost. |
Yes. You pay more for out-of-network providers and fewer health services may be covered. |
How do I pay for services? |
There is no deductible. You are charged a copayment (typically between $20 and $40) for a physician office visit.
You usually do not need to fill out claim forms.
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If you use an in-network provider, there is no deductible and you are charged a copayment. You do not need to fill out a claim form. If you use an out-of-network provider, you may pay a deductible and a greater portion of the medical expenses. You may need to fill out a claim form. |
Do I need to choose a primary care physician (PCP)? |
Yes. You are usually required to choose a PCP from a list of in-network doctors. Your PCP takes care of most of your medical needs. |
Yes. You usually need to choose a PCP from the list of in-network doctors.
You have the option of using the PCP or going to a doctor who is out-of-network.
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Do I need a referral from my PCP to see a specialist? |
Yes. Before you go to a specialist, you usually need a referral from your PCP. |
You usually need a referral from your PCP to see an in-network specialist, and to be covered with the maximum benefit with minimum cost to you.
You do not need a referral to see an out-of-network specialist, but you will probably pay more in coinsurance and deductibles.
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