Page 3 - PA_PPO_Member_Kit

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About Your Plan
What is an HMO?
HMO stands for health maintenance organization. All of your care is arranged through a personal care
physician (PCP) who will help you choose a specialist when you need one. (Learn more about choosing
a PCP in the section called Selecting Your Doctor.) You will need a referral from your PCP in order to
get specialty care. Except for emergency care, you do not have coverage for out-of-plan services.
What is a PPO?
PPO stands for preferred provider organization. You don’t have to select a personal care physician
(PCP) if you don’t want to. However, you are encouraged to use a PCP so that you receive the most
complete care possible. When you belong to a PPO plan, you are covered for preventive services if you
receive care from an affiliated provider. If you decide to use a specialty provider who is not affiliated,
you may pay higher out-of-pocket costs.
What is a POS?
POS stands for point-of-service. You have the option to select a personal care physician (PCP), but it is
not required. You are covered for preventive services if you receive care from an affiliated provider.
You can receive care from any affiliated or non-affiliated specialist. If you decide to use a non-affiliated
specialist, you’ll pay higher out-of-pocket costs.