Health Insurance Glossary Terms

Here you'll find definitions of basic terms used throughout this site. If you are unable to find an answer to your question, please visit our Frequently Asked Questions section, or contact us directly.

• HMO
• Point-of-Service Plan
• Preferred Provider Plan

HMO: An HMO (Health Maintenance Organization) is a type of health plan in which your care is managed by your Primary Care Physician (PCP). An HMO can differ from traditional insurance programs by focusing on wellness and disease prevention, rather than simple reimbursement after illness or injury strikes. The HMO approach makes it easier for physicians to do what they do best - safeguard the health of their patients. Northern Illinois Health Plan HMO offers access to primary care physicians, specialists and hospitals nationwide, with the convenience of reduced paperwork and lower out-of-pocket costs.

Point-of-Service Plan: A Point-of-Service plan is a managed health care plan that combines the advantages of a PPO and an HMO. Participants select a Primary Care Physician (PCP) participating in the Northern Illinois Health Plan to provide routine and preventative health care.

When you need care, see your PCP first and keep your out-of-pocket costs at their lowest and your coverage levels at their highest—with no need to file claim forms. Your PCP can provide referrals to network specialists and will obtain authorizations for hospital admissions, lab or x-ray services or outpatient procedures at participating facilities.

Preferred Provider Plan: As a PPO plan participant, you enjoy the highest level of benefits and lower out-of-pocket expenses when you receive care from Northern Illinois Health Plan participating physicians. You don't need to select a PCP and you can see any participating provider you choose, even a specialist, whenever you choose. There are no referrals for hospital, outpatient or ancillary services, and no claim forms when you receive care from participating providers.