Health insurance in Florida is currently available in four different types of managed care options. While many states and insurance companies only offer the three major types of this style of insurance, Florida also has one additional choice for managed care. This fourth choice is the exclusive provider organization, or EPO. In an EPO plan that is administered in this state, the insurance company contracts rates directly with the network providers and hospitals. The insured will only receive benefits from the plan if treatment is under the care of one of those network providers. There are generally no out of network provisions, unless the treatment stems from an emergency situation.
The most flexible type of managed care health insurance in Florida is the preferred provider organization, or PPO. In a PPO plan, the insured is given a list of in-network primary care physicians, specialists, and medical care centers. If the insured chooses to use one of the in-network providers, the costs will usually be lower, often with decreased co-payment amounts. This type of plan does offer the insured the freedom to choose providers outside the network. Those costs will be covered by the plan, but as they are non-negotiated rates, they will be higher. The premiums paid for a PPO plan will likely be slightly more than those for other types of managed care policies.
The health maintenance organization or HMO is one of the most affordable choices for health insurance in Florida. The HMO will charge the insured a fixed monthly fee and in return the insured will have access to the HMOýs network of care providers. Usually HMO members will pay a set rate for office visits and prescriptions. If treatment is necessary by a provider outside the network, the insured must obtain the proper referrals for the costs associated with that treatment to be covered.
The point of service plan, or the POS, is probably the least understood of the managed care options for health insurance in Florida. The POS plan also has a network of providers with a lower negotiated cost to the insured. In this plan, the insured may seek treatment outside the network, but will have to pay a higher percent of co-insurance. Some types of out of network treatments may not be covered under a POS plan, such as prescription drugs or mental health services. Under a POS plan, there is usually a deductible amount that must be met before any costs will be paid for out of network treatments.