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Description of Medical Plans

PPO - plan encourages you to choose doctors, hospitals, and other providers that participate in the plan. They do this by increasing the portion of the bill they pay if you stay “in network.” You may choose to go “out-of-network” at any time, but if you do, you’ll have to pay a higher percentage of the provider’s bill. Other than physician office visits and emergency care, services must usually be authorized by the PPO before you receive them. Some PPOs have a primary care physician who is responsible for coordinating your medical care.

HMO - Health Managed Organization - plan requires that you select a primary care physician (PCP) within the HMO provider network. Your PCP is responsible for meeting your health care needs, either by taking care of you directly or by referring you to other providers (such as specialists). As long as you see your PCP or have an authorized referral to another provider, your out-of-pocket cost is usually a relatively small copayment per visit. But if you chose to go to another provider without a referral--whether or not the providers are in the HMO network--you'll have to pay 100% of the provider's bills. The exceptions are true emergency situations for which you are covered by the plan. 

EPO - Exclusive Provider Plan- is very similar to an HMO. With an EPO, you must select a primary care physician or physician gatekeeper who will be responsible for meeting your health care needs. In most EPO plans, as with an HMO, if you choose to go out-of-network, you'll have to pay 100% of the provider's bills. 

POS- Point Of Service - This is a variation of the HMO and EPO plans and is often described as an open-ended HMO. As with an HMO, you must pick a primary care physician within the network. You pay least when you receive services from your PCP or through an authorized referral to another provider. But unlike an HMO, you may opt out of the network. If you opt out you'll be responsible for paying a portion of the provider's bills. 

Please check your Medical Insurance if you want your Refraction covered. Most Medical Insurance does not cover Refractions*. (*Eye examination for glasses, they don't cover it because it is not a medical benefit) 

But if you do have Vision Insurance, please let us know in advance on what the plan is. There are some plans that do require prior authorizations or special arrangements to be made in advance. If you are a member of VSP or Vision Service Plan. You can check your eligibility online. 

If you do have another coverage not listed. Please call your plan or look at the listing of providers in your medical plan book. If you are still in need of help please call: 650-342-7474

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