Health, they say, is wealth and one of the ways it can be safeguarded is through a health insurance network. Health is not only a sign of good living but also a precious and valuable part of our everyday life.
A good health does not only mean that one doesn’t have a disease but that they are physically, socially and mentally upright.
One of the safety nets that caters for people’s financial well-being in situations where they are faced with medical emergencies is health insurance.
A health insurance is a contract (usually a 1-year agreement) between an individual and a company in which the individual pays a monthly premium in return for having some or all of their healthcare cost paid for.
With a good health insurance policy, one can pay for their medical expenses that might stem from injuries, illness or accidents.
But what then is a health insurance network and how does it work? In this article, we’ll provide everything you need to know about health insurance network
What is a Health Insurance Network
A health insurance network is a list of health care providers like doctors, nurses, dieticians, nutritionists, hospitals, pharmacies, nursing homes, and other healthcare facilities that have a planned contract with an HMO, POS, PPO, and EPO to provide medical care to their members.
In a typical healthcare insurance plan, a healthcare insurance network plays the role of providing quality care as well as access to it while ensuring that policyholders receive the best medical care possible.
Benefits of a Health Insurance Network
Other than receiving quality medical care as a member or policyholder, there are other benefits of health insurance network. Here are some of them:
Save money
One of the major benefit of a health insurance network is that it helps one to save money.
When your insurance company aligns with the providers in your health insurance network, they (the providers) charge you based on the plan you have with the insurance company and not the general way they charge other.
Quality medical care
Another advantage of a health insurance network is that one gets to enjoy quality medical care.
Since health insurance network usually has a planned contract with HMOs, POSs, PPOs, and EPOs for the benefit of their policyholders or members, the best health care providers are usually selected for it.
Hence, members get to benefit quality medical care provided by some if the best health care providers.
Preventive and coordinated care
Most health insurance networks do offer preventive services Lile checkups, screenings, vaccinations, etc, at no additional cost.
This is unlike the regular medical care which would require one to pay extra for some of these things.
Health insurance networks also provide coordinated care with medical records stored safely and treatment plans scheduled at the appropriate time for members.
Wellness programs
Health insurance networks usually go the extra mile to offer their members the best services as s a result of their planned contract with HMOs, POSs, PPOs, and EPOs. One of these services are wellness programs.
Through wellness programs policyholders get to enjoy discounts on weight management support programs, smoking cessation programs, gym memberships, among others.
Types of Health Insurance Networks
Although there are a lot of health insurance networks out there that one can choose from, just four out of them are the most common and these four differ based on their cost and where their services can be gotten from.
The four most common types of health insurance networks are Health Maintenance Organization (HMO), Point of Service (POS), Preferred Provider Organization (PPO) and Exclusive Provider Organization (EPO).
Health Maintenance Organization (HMO)
This type of health insurance network is known to have policies that only provide coverage for facilities and doctors that are in contract with it.
One thing that makes it stand out among some other health insurance networks is that its services include integrated care like wellness programs and preventive measures for health challenges.
Point of service (POS)
Point of Service health insurance network is known to have health insurance plans which allow their policyholders or members to pay less that the usual amount whenever they visit an in-network hospital or doctor.
Infact, unlike Exclusive Provider Organization (EPO) – which is another type of health insurance network – Point of Service health insurance network allow their members to visit out-of-network hospitals and doctors.
The only downside to Point of Service health insurance network is that their members are required to pay a higher monthly premium health insurance plan because of the freedom given to them to choose healthcare providers of their choice.
Preferred Provider Organization (PPO)
This type of health insurance network is known to offer cost sharing benefits to members who visit in-network healthcare providers.
PPO differs from a network organization like EPO in the sense that when members go to out-of-network healthcare providers for medical services they receive the same cost sharing help that would usually receive from in-network healthcare providers.
Also, unlike some other health insurance networks that would require their members to first visit a primary care provider and get a referral before they can visit a specialist for their medical services, Preferred Provider Organization (PPO) is different.
With PPO, members are allowed to visit specialists without referral from a primary care provider.
The only advantage of Preferred Provider Organization (PPO) is that it costs more than some other types of health insurance networks.
This is because members are given the flexibility to choose where they want to receive their coverage.
Exclusive Provider Organization (EPO)
Exclusive Provider Organization (EPO) is a type of health insurance network that offers cost sharing benefits to members only when they visit in-network healthcare providers.
In a situation where these members decide to go to out-of-network healthcare providers for medical services, they would be required to bear the full cost.
This is unlike a health insurance network like Preferred Provider Organization (PPO) which shares cost with members whether they are visiting in-network healthcare providers or out-of-network healthcare providers for medical care.
Which Health Insurance Network is the Best
Generally, there is no specific answer for which of the four common health insurance network is the best. This is because the healthcare needs of people and their cost varies.
The best health insurance network for one depends on the medical service they need and what it would cost for that service to be offered.
For instance, for someone who is not bothered about where they receive coverage from a health insurance network, they might decide to settle for a health insurance network like Health Maintenance Organization (HMO).
On the other hand, for someone who would often want to see a specialist and would need increased flexibility to do that, they would want to opt for Preferred Provider Organization (PPO).
Conclusion
Health insurance networks are healthcare providers who have planned contract to provide quality care to their members and ensure they receive the best medical care possible.
Although there are many types of health insurance networks, the most common ones are Health Maintenance Organization (HMO), Point of Service (POS), Preferred Provider Organization (PPO) and Exclusive Provider Organization (EPO), and people’s choice if them depend on the type of medical service they need.