Benefits Blog

Word of the Day - IHM

​Now that we know the difference between an EPO and a PPO, let's talk about an IHM, or Integrated Health Model.

While this type of plan is not new, the number of such plans in the marketplace has increased because of healthcare reform (aka the Affordable Care Act or ACA). The ACA included language encouraging the use of "accountable care organizations" which are health plans or health systems that agree to manage a specific group of participants' total healthcare needs. Under the State Employee and Retiree Health and Welfare Program (the Program), Kaiser is the health plan that administers our IHM.

For those enrolled in this plan, your care is provided​ exclusively by Kaiser practitioners in Kaiser facilities.  These facilities often house a multitude of services including x-ray and lab, various specialists, and primary care physicians.  IHM's are often referred to as "one-stop shops" for this reason.  Participants choosing this type of plan like the convenience of having all of their providers available in one place.

As with the EPO plans, the IHM plan has no coverage for care or services received outside of its facilities (think "out of network"). Care received elsewhere is paid for entirely by the participant.