A proprietary preferred provider organization health plan allows individuals to choose from a broad range of health care providers within a network. The providers sign a contract with NHAI to provide discounted health care services to plan members. Under a PPO plan, members do not need to choose primary care physicians and typically don’t need to obtain referrals before visiting specialists. PPO plan members may also be covered when visiting out-of-network providers.
An individual covered by a health maintenance organization (HMO) plan must choose a primary care physician to visit for all health care services, excluding emergencies. In order to visit a specialist, HMO plan members must receive a referral from their primary care physician to ensure that the specialized services will be covered. However, women are not required to obtain a referral to receive obstetrical or gynecological care for routine tests and services.