Health Insurance Plans

HEALTH INSURANCE
PLANS
WELCOME AND INTRODUCTIONS
Welcome to the Health Insurance Plans course. In this course you are
introduced to the different plans that insurance companies may provide for
their members including:
• · Types of Health Insurance plans
• · Various metal levels associated with health insurance plans
• · Flexible Spending Account (FSA) Accounts available to members
COURSE OBJECTIVES
After completing this course, you will be able to:
• · Define the types of health insurance plans.
• · Explain how each plan type covers different services.
• · Explain the differences between each type of health care plan.
• · Explain the different metal levels of coverage for health insurance plans.
• · Define each type of FSA.
• · Explain how each type of FSA works.
ACTIVITY
Types of Health Insurance Plans
• In this activity, you will work with your group to research information on
the types of Health Insurance plans people can choose from. Use the Types
of Health Insurance Plans document to answer the questions you are
assigned. Phrase the answer in your own words.
TYPE OF INSURANCE PLAN
• Health maintenance organizations (HMOs)

• Preferred provider organizations (PPOs)
• Exclusive provider organizations (EPOs)
• Point-of-service (POS) plans
• High-deductible health plans (HDHPs), which may be linked to health
savings accounts (HSAs)
HEALTH MAINTENANCE ORGANIZATION
(HMO)
An HMO delivers all health services through a network of healthcare
providers and facilities. With an HMO, you may have:
• The least freedom to choose your health care providers
• The least amount of paperwork compared to other plans
• A primary care doctor to manage your care and refer you to specialists
when you need one so the care is covered by the health plan; most HMOs
will require a referral before you can see a specialist.
PREFERRED PROVIDER ORGANIZATION (PPO)
With a PPO, you may have:

• A moderate amount of freedom to choose your health care providers -- more than an
HMO; you do not have to get a referral from a primary care doctor to see a specialist.
• Higher out-of-pocket costs if you see out-of-network doctors vs. in-network providers
• More paperwork than with other plans if you see out-of-network providers
• What doctors you can see. Any in the PPO's network; you can see out-of-network
doctors, but you'll pay more.
EXCLUSIVE PROVIDER ORGANIZATION (EPO)
With an EPO, you may have:

• A moderate amount of freedom to choose your health care providers --
more than an HMO; you do not have to get a referral from a primary care
doctor to see a specialist.
• No coverage for out-of-network providers; if you see a provider that is not
in your plan’s network – other than in an emergency – you will have to pay
the full cost yourself.
• Lower premium than a PPO offered by the same insurer
POINT-OF-SERVICE PLAN (POS)
A POS plan blends features of an HMO with a PPO. With POS plan, you
may have:
• More freedom to choose your health care providers than you would in an
HMO
• A moderate amount of paperwork if you see out-of-network providers
• A primary care doctor who coordinates your care and who refers you to
specialists
HIGH-DEDUCTIBLE HEALTH PLAN WITH OR WITHOUT A
HEALTH SAVINGS ACCOUNT
You may be able to pay less for your insurance with a high-deductible health plan (HDHP). With an HDHP,
you may have:
• One of these types of health plans: HMO, PPO, EPO, or POS
• Higher out-of-pocket costs than many types of plans; like other plans, if you reach the maximum out-of-
pocket amount, the plan pays 100% of your care.
• A health savings account (HSA) to help pay for your care; the money you put in an HSA is not taxed and
can be used tax-free on eligible medical expenses. In order to have an HSA, you must be enrolled in an
HDHP.
• Many bronze plans may qualify as HDHPs depending on the deductible (see below).
HEALTH SAVINGS ACCOUNTS
1. Health Savings Account (HSA)
• A Health Savings Account (HSA) is a tax-advantaged account to help
people save for medical expenses that are not reimbursed by high-
deductible health plans (HDHPs)
2. Flexible Spending Account (FSA)
• A flexible spending account (FSA) is a type of savings account, usually for
healthcare expenses, that sets aside pretax funds for later use.
3. Health Reimbursement Account (HRA)
• A Health Reimbursement Arrangement (HRA) is a reimbursement account
set up and funded by your employer to help participants pay for covered
eligible healthcare products and services not covered by any other source.
The employer defines the services eligible for reimbursement from an HRA
based on a list of IRS approved eligible expenses.
4. Medical Savings Account (MSA)

• Medical savings account (MSA): This is a special type of savings account.
Medicare gives the plan an amount of money each year for your health
care expenses. This amount is based on your plan. The plan deposits
money into your MSA account once at the beginning of each calendar year.
SUMMARY
Congratulations! You have completed Health Insurance Plans course. You should now
be able to:
• · Define the types of health insurance plans.
• · Explain how each plan type covers different services.
• · Explain the differences between each type of health care plan.
• · Explain the different metal levels of coverage for health insurance plans.
• · Define each type of FSA.
• · Explain how each type of FSA works

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HEALTH INSURANCE

• Health maintenance organizations (HMOs)

With a PPO, you may have:

With an EPO, you may have:

4. Medical Savings Account (MSA)

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