Insurance coverage for mental health (MH) and substance abuse (SA) benefits differs among plans, employers, and States. State laws may require insurers to provide a standard, minimal offering of MH and/or SA benefits although insurers are free to provide additional coverage. In general, mental health benefits are not as extensive as medical/surgical benefits and will require higher deductibles and co-payments in addition to any regular, fixed payments.
The following are common types of managed care health insurance plans:
a. PPOs, Preferred Provider Organizations, are sometimes referred to as fee-for-service plans. PPOs differ from FFS plans in that they use a network of providers and usually charge lower fees.
a. Under a HMO, a POS allows consumers to visit health care providers outside the HMO’s network as well as providers inside the network. Using a provider outside the network requires will result in higher copayments and deductibles, and you may have to file a claim for reimbursement.
b. Under a FFS plan, consumers can visit the provider of their choice. There may or may not be a network of providers – if there is a network, consumers are usually offered lower copayments and/or no deductible to see a provider within the network.