Managed Care Plans

Managed Care Plans

• Have agreements with certain physicians, hospitals and health care providers to provide a range of services.
• Include PPOÕs, HMOÕs and POSÕs. PPOÕs have arrangements with physicians, hospitals and other providers of care.
• PPO physicians can make referrals, but plan members can also refer themselves to other physicians, including one outside of the plan.
• HMOÕs provide a list of physicians to choose from to select a primary care physician. The primary care physician coordinates all care and needs to be visited or contacted in order to receive a referral to another physician or specialist.
• POSÕs primary care physicians in a POS plan usually make referrals to other providers in the plan. Members can refer themselves outside of the plan and can still receive some coverage.

America's Health Insurance Plans (AHIP)

202-778-3200 Website

AHIP is a national association of health insurers which provides consumer information on a number of different health insurance plans. The AHIP website also offers resource guides on health insurance and managed care.

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