Florida Plan Types: HMO to Dread Disease

HMO: comprehensive prepaid care through a closed network — members are NOT covered outside it; the primary physician is the gatekeeper; emphasis on preventive care. PPO: care in or out of the preferred network; in-network means lower out-of-pocket costs and providers can't charge beyond the copay, while out-of-network providers may charge the difference between billed and paid. EPO (F.S. 627.6472): a provider with a written agreement with an insurer to serve specific (exclusive) insureds through its own facilities, a professional network, or another entity such as an HMO. PLHSO: a Prepaid Limited Health Service Organization delivering LIMITED services through an exclusive panel — ambulance, dental, vision, mental health, substance abuse, chiropractic, podiatric, or pharmaceutical services. Indemnity (hospital fixed-rate) plan: pays a set daily/weekly/monthly amount per day hospitalized (e.g., $100/day), minimal underwriting, benefits paid directly to the insured with no restrictions, benefit periods from 6 months to lifetime. DMPO (F.S. 636.202): a Discount Medical Plan Organization sells discounted ACCESS to providers — licensed by the Office of Insurance Regulation but NOT insurance, and its marketers need no agent license. Dread disease / critical illness: medical expense coverage for specific illnesses (cancer, heart disease), frequently paying a single lump sum on diagnosis.

From tightest to loosest: HMO locks the network, PPO discounts it, EPO contracts it, PLHSO shrinks the menu, indemnity just mails checks, DMPO only sells coupons, and dread disease bets on one diagnosis.