|  | Healthcare Industry | HMOs

Harvard Pilgrim Health Benefits

For over 30 years, Harvard Pilgrim Health Insurance Company has provided health insurance to members across Maine, New Hampshire and Massachusetts. For four years in a row, the US News and World Reports has rated Harvard Pilgrim Health Insurance the number one in their America's Best Health Plans edition. They offer over ten different health insurance plans to choose from with a range of benefits. Plans fall into four basic types: HMO, PPO, POS and Core Coverage.

  1. HMO Plan

    • Harvard Pilgrim's HMO (Health Maintenance Organization) Plan is one of the simplest and most comprehensive forms of coverage they offer. Under this plan, your Harvard Pilgrim-affiliated primary care physician does the work to provide you with the care you need, either providing services directly or offering referrals to in-network healthcare providers. Routine, specialty, emergency and preventive care are all covered, and coverage travels with you.

    PPO

    • PPO, or Preferred Provider Organization, programs at Harvard Pilgrim offer care through third-party organizations of doctors and health care providers. In-network services from participating providers as well as out-of-network services from other providers are covered under this plan. In-network services have low co-payments and cover most health services. Under this plan, you are not required to have a primary care physician or a referral to receive care. All medical emergencies, such as heart attack or stroke, are covered.

    POS plan

    • Harvard Pilgrim's Point of Service (POS) plans combine elements of HMO and PPO plans. In this type of plan, patients choose their primary care physician from the Harvard Pilgrim network, who acts as their "point of service" for care. Your physician will provide you with any services you need, such as checkups, screenings, and immunizations, or will refer you to specialists in or out of the Harvard Pilgrim network. Some benefits packages also include prescription drug coverage.

    Core Coverage

    • Harvard Pilgrim also offers the Core Coverage plan, which provides essential benefits at lower premiums than traditional health care plans. There are two different payment plans for benefits under this plan.

      Patients can make co-payments for up to three individual and six family outpatient medical visits or behavioral health visits, as well as emergency care and allergy shots.

      Additional outpatient or behavioral health visits, and any procedures, such as X-rays, shots, lab tests, mammograms, hospital services and daytime surgery, require payment of an annual deductible plus coinsurance.

    Other Types of Coverage

    • Harvard Pilgrim also offers special plans for seniors entitled to Medicare, the Pulse Plan, designed for young adults 18 to 26 who may not be eligible for health insurance through their employer, as well as student health insurance plans offered through select colleges and universities.

HMOs - Related Articles