HMO stands for “Health Maintenance Organization”. It is a prepaid medical group practice plan which provides comprehensive medical benefits.
PPO stands for “Preferred Provider Organization”. It is a group of hospitals and physicians contracting on a “fee-for-service” basis with insurance companies to provide comprehensive medical service. It differs from an HMO in that you are free to choose your own health care provider. The Fund’s own Managed Health Care Plan is a PPO.
Coordination of Benefits (COB) is a process designed to eliminate duplicate payments and apply primary and secondary coverage when a participant is insured under two health plans.
Your health and welfare plan defines Physician as:
“(a) a physician and surgeon (M.D.) licensed to practice medicine in the state in which he practices and (b) any other practitioner of the healing arts who renders care or treatment within the limits set forth in the license issued to him by the applicable agency of the state in which he renders such care or treatment.”
Among the practitioners of the healing arts are Certified Acupuncturists (when treatment is for a pain-related diagnosis), Nurse Midwives (for obstetrical care, provided services are performed in a hospital as defined by the Plan), Nurse Practitioners, and a licensed Ph.D., M.F.C.C., or L.C.S.W.
If you wish to check whether a health care provider fits the definition of Physician, contact the Fund Office.