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HMO, PPO, EPO, POS, or Fund Insurance

Brandt R Gibson, DPM
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Podiatrist, Neuropathy Doctor, Father of 11 and Founder of Mountain West Foot & Ankle Institute
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           HMO:  A health maintenance organization is a managed care plan that requires members to pick a Primary Care Physician (PCP) and obtain referrals to see medical specialists.  Similar to a PPO, an HMO also contracts with doctors and facilities for reduced rates for its members.

            PPO:  A Preferred (or Participating) Provider Organization is a managed care organization of medical doctors, hospitals, and other health care providers who have contracted with an insurance company to provide health care at reduced rates to the insurance’s members.  Unlike an HMO, a PPO doesn’t require a referral to see other doctors.

            EPO:  An Exclusive Provider Organization is a type of managed care plan that combines some features of HMOs and PPOs. There is very little difference between an EPO and PPO except that an EPO has a more limited network of doctors/facilities, but it is also slightly less expensive.

            POS:  A Point Of Service plan is a managed care plan that combines the features of HMOs and PPOs.  A member must choose a Primary Care Physician (PCP) from within the plan’s network of providers.  A member’s PCP may then refer them to doctors out of network.

           Fund:  A fund or trust is not truly insurance, but a means of paying medical costs.  Members of the fund/trust pay into it and funds are dispersed to pay medical claims of the members and their dependents.  Examples of Funds/Trusts are United Mine Workers of America Health & Retirement Fund, Union Pacific Railroad Trust, and Arizona Pipe Trades Health & Welfare Trust. 

Part of the "Understanding Insurance" series.  

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