How to Understand Your Health Insurance & Medical Insurance Plans

How to Understand Your Health Insurance & Medical Insurance Plans

  • Different health insurance providers have different plans, which can make taking out health insurance difficult to understand.
  • However, there are some common policies that almost all companies offer, including PPO, HMO and POS.
  • Learn more about these policies and what they cover in this guide.

Health insurance or medical insurance plans are usually not understood by people as usually they are taken for granted to be availed through the employers, but even if you are buying it individually even then you have to rely upon the insurance agents for these plans.

Different health insurance companies offer different insurance plans which makes it more difficult to understand these plans.

In this article, we look at some of the basic information about health and medical insurance plans to help you understand how these plans work.

Types of Health Insurance Plans

Though different insurance companies design their health and medical insurance plans differently, there are some common plans found with almost all companies. These include:

  1. Preferred Provider Organizations Plan (PPO)
  2. Health Maintenance Organization Plan (HMO)
  3. Point of service plan (POS)

1. Preferred Provider Organizations Plan (PPO)

You can enjoy the medical services from any licensed physician or medical service provider under this plan as it reimburses the medical bills payable to them but you can get better benefits if you take the services of Network Providers including hospitals or doctors contracted by the insurance company.

This plan also assures you about being overcharged by the network providers due to the contract between the providers and the company.

2. Health Maintenance Organization Plan (HMO)

This health and medical insurance plan allows you to get coverage from the Network Providers only. You will not be getting any reimbursement of the medical bills of the services taken out of Network except you are facing a life-threatening problem. Moreover, your choice for network provider is limited in this plan by contacting one after prescription of Primary Care Physician only.

3. Point of service plan (POS)

This plan offers the facilities of both the health insurance plans discussed above. The benefits are provided in this plan as per the use of the providers. You will get maximum reimbursement of medical bills if you use the providers networked with the HMO plan but if you use providers contracted under PPO plan you will get lesser reimbursement. The level of reimbursement of bills will further decrease if you take services of the providers entirely out of the network providers.


Even after understanding the health and medical insurance plans you need not have to remember about the benefits you are getting under either of these plans as some things are covered under these plans and which things are not covered under them you will have to pay from your own pocket.

Even if you want to keep a record of the benefits you are going to get under that plan you can request a copy of your coverage plan from the insurance company. Similarly, if you have individually purchased a health insurance plan, you can ask for a certificate of coverage or insurance policy from the insurance company.

You can ask the company or the insurance agent if you can not locate the benefits written on the copy of the health insurance plan.

Thus, one can easily understand the health and medical insurance plans if he thoroughly reads out the copy of the insurance coverage certificate issued by the insurance company

Melissa Davis

marketing at Australian Foundation

Melissa Davis is journalist and marketing specialist from Australia, she has been writing about health, travel, and other topics on blogs across the Internet. Melissa lives in Brisbane with her husband and young daughter where she enjoys parenting, cycling, and other extreme sports.