OHA: Compare Providers

Health Plans

Compare Providers

In the managed care industry, the word "provider" refers to a physician, hospital, nursing home, pharmacy, lab or any individual or group that provides a health care service.

Many managed care health plans have contracted with providers to deliver medical/health care services to the enrollees for an agreed upon charge--they would be called "participating providers."

Typically, a managed care health plan has a "network" of providers. This requires that those enrolled in that plan need to seek care from a provider in that network in order to receive the highest level of benefits. If the enrollee chooses to go "out of the network," this would generally provide coverage at a lower level of benefits.

It is important for you to understand which types of plans are offered to you and to know about the providers and the network of providers that your plan has contracted with before you sign up for that plan.