Most of us who are employed know that we have corresponding health insurance. For others who choose their own insurance, agents might have explained what should be provided and covered for our policies.

2. Most of us who are employed know that we have corresponding
health insurance. For others who choose their own insurance,
agents might have explained what should be provided and
covered for our policies.

3. One of the things that we should be aware of is
the type of a managed care plan we need:
either an HMO or PPO to avoid complaints,
frustrations and disappointments added to our
consultation to the doctor.If this is the first time
you are hearing this, then, you are not alone.
Some insurance are already fixed that agents
do not care to mention it anymore.

4. Westhill Insurance Consulting took the liberty to
differentiate each one from the other.Westhill Insurance Consulting took the liberty
to differentiate each one from the other.

5. HMO actually stands for Health Maintenance
Organization while PPO is an abbreviation of
Preferred Provider Organization. Less common are
point-of-service (POS) plans that combine the
features of an HMO and a PPO. In developing cities
like Singapore, Kuala Lumpur, Malaysia, Jakarta,
Indonesia and Beijing China, HMO is mostly used by
employers for their health care insurance.

6. To put into an outline, here are the
facts that are needed to be reviewed
and considered between the two:
• HMO: you must choose doctors, hospitals and other providers
• PPO: you can choose doctors, hospitals and other providers.
Do I need to choose doctors, hospitals and other providers?

7. Do I need to have a Primary Care Physician (PCP)?
• HMO: Yes, your HMO will not provide coverage if you do not
have a PCP.
• PPO: No, you can receive care from any doctor you choose. But
remember, you will pay more if the doctors you choose are not
"preferred" providers.

8. How do I see a specialist?
• HMO: Referral is needed from your PCP to see a specialist or
if you have to undergo other special test exams such as x-
rays, except in emergency situations. Your PCP also must
refer you to a specialist who is in the HMO network.
• PPO: You do not need a referral to see a specialist. However,
some specialists will only see patients who are referred to
them by a primary care doctor. And, some PPOs require that
you get a prior approval for certain expensive services, such
as MRIs.

9. Do I have to file any insurance claims?
• HMO: All of the providers in the HMO network are required
to file a claim to get paid. You do not have to file a claim,
and your provider may not charge you directly or send you
a bill.
• PPO: If you get your healthcare from a network provider
you usually do not need to file a claim. However, if you go
out of network for services you may have to pay the
provider in full and then file a claim with the PPO to get
reimbursed. The money you receive from the PPO will most
likely be only part of the bill. You are responsible for any
part of the doctor's fee that the PPO does not pay.