Plan types & referrals

There are several types of health plans that you can choose from. Each plan works a little differently and is associated with a network of doctors, hospitals, and other health care providers.

The type of plan you choose will affect the process you'll follow to get care. Whether you have a primary doctor and whether you'll need referrals from that doctor are the biggest differences between the plans.

  • HMO (Health Maintenance Organization) - Best if you have or want a primary doctor to coordinate your care and refer you to specialists who are within the network you choose. HMO plans offer coverage for network doctors only.
  • HMO Plus - Best if you have or want a primary doctor to help coordinate your care but you still want the freedom to choose a particular doctor or hospital, without a referral. HMO Plus plans offer coverage for network doctors only.
  • POS (Point-of-Service) - Best if you have or want a primary doctor to coordinate your care but you still want the freedom to choose a particular doctor or hospital, in- or out-of-network. POS plans offer the highest level of benefits when you visit providers that participate within the network, but provide the option of seeking care outside of your network if you choose.
  • POS Plus - Best if you have or want a primary doctor to coordinate your care but also want the freedom to see whatever specialist you want, in- or out-of-network, without a referral. All POS Plus plans are available with the National Access network.
  • EPO (Exclusive Provider Organization) - Best if you want the freedom to see any doctor or specialist you want with no referral, as long as they’re within the network you choose.
    • EPO with HSA (Health Savings Account) - Adding an HSA can save you money if you choose a plan with a high deductible. You can put money into an HSA, and you won’t get taxed for that part of your income. Then you can use that money to pay for approved health costs. Learn more about HSA
  • PPO (Preferred Provider Organization) - Best if you want an expansive network and the freedom to see any doctor or specialist you want, in- or out-of-network, without a referral.
Referral
A referral is like an official doctor's note. Your doctor sends a message to the specialist's office notifying them that you need to see them for medical care. After the referral is received, you can make an appointment with the specialist.