Types of Plans |
Types of Coverage
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PPO plans
are preferred provider plans. Health insurance
companies contract a network of doctors and
hospitals that are “preferred” by the company.
These network doctors and hospitals charge a
contracted fee for their services and when you
choose to see one of these “preferred
providers,” the amount you pay out of your
pocket is usually quite low. There is typically
a small co-payment (a fee per visit or service),
which may be $15 or $20. It is important to keep
in mind that since the insurance companies keep
prices lower by contracting specific doctors and
hospitals, there is higher charge for going out
of the healthcare provider’s network. However,
the PPO is a more flexible arrangement than many
other plans because the plan will pay some of
the costs if you choose to visit a doctor,
specialist, or clinic outside the network. For
example, if you want to see a world renowned
specialist at the John Hopkins Clinic, your PPO
plan would reimburse you for at least some of
the cost.
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Point of Service
(POS) plans have similarities to both
PPO and HMO plans. As with Preferred Provider (PPO)
plans, you are directed toward a network of
contracted doctors, hospitals and clinics for
your healthcare, but you can pay a larger
out-of-pocket fee to visit an out-of-network
provider. In line with the managed care policies
of an HMO, your healthcare is administered
according to a healthcare professional. With a
Point of Service plan your primary doctor
oversees your medical care and refers you to
contracted specialists when the need arises.
Akin to the philosophy of an HMO, POS plans
promote health and wellness through prevention
and education, in addition to treatment.
The upside to a Point of Service
plan is the freedom to go out on your own and
chose your own providers, even specialists,
outside the network. You are never limited to
medical providers your primary care physician
refers. However, be aware, the dollar amount the
plan will pay decreases when you go outside the
network. You will pay approximately $600 a year
for the privilege of being allowed to self-refer
to out-of-plan practitioners, and your
out-of-pocket contribution will be greater. It
is wise to consider if it is worth it to you, as
a consumer, to pay a higher monthly payment for
the freedom to access specialists, physicians,
and clinics of your choice. If you are
relatively healthy and do not have a special
relationship to a specific physician, then you
might consider a managed care program that will
charge you less to exercise less freedom in
choosing a healthcare provider. If the freedom
to self-refer to any healthcare practitioner or
hospital you want is important to you, a POS
plan may be your ideal fit.
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A
health maintenance organization (HMO)
provides “managed care” in return for a monthly
or quarterly premium. You pay a fee, the amount
depending on the specifics of your coverage, and
are offered a range of health benefits that
cover the entire spectrum from preventive care
and education to physician care, surgery and
hospitalization. An HMO is a one-stop shop for
all your healthcare needs. Your healthcare is
“managed” by your primary care physician,
usually a general practitioner.
Typically, you must receive a
referral from your physician before visiting a
specialist outside the provider network. With
rare exceptions, such as when you are away
traveling, you are limited to seeking care
completely within the network of providers,
doctors, hospitals and labs with whom your HMO
has negotiated a fee schedule. Since contracting
discounts from a network of providers is one of
the primary ways a HMO maintains cost
effectiveness, the plan only works when you stay
within the network. In addition to your premium,
an HMO generally charges a co-payment (a way of
sharing per visit costs between the consumer and
the plan) of, for example, $10 or $20 for
certain services or prescriptions. One of the
unique features of an HMO is that they typically
deliver care directly to patients. Patients
visit an HMO’s medical facility to see the
physicians. Most HMOs own their own hospitals
and clinics and directly hire physicians who
work only for them. A quintessential example is
the Kaiser Permanente System.
While an HMO is more restrictive
than other plans, it can be a convenient and
cost effective solution for an insurance
consumer that does not have ties to a doctor or
medical facility outside of the HMOs network. If
the organization is well run, doctor visits and
healthcare can be simple, hassle-free and
reliable. If the need arises for you to see a
specialist, your doctor will handle the research
for you, all you will need to do is show up for
your scheduled appointment.
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As of January
1, 2004, healthcare consumers have a new way to
help manage their own healthcare. Health
Savings Accounts (HSAs) provide
consumers with added insurance coverage and
control. Flexibility is the key component of an
HSA. Anyone with a high-deductible health plan
can set up a health savings account to save
money on medical care now, as well as save for
future medical expenses. You may use HSA funds
to pay for expenses that must be met before your
deductible, to pay for services not covered by
your health plan (such as alternative therapies
or out-of-network providers), or insurance
coverage during periods of unemployment.
Even if you purchase your
insurance plan or your health savings account
through your employer, you still own your
account. You make the decisions on how much to
contribute to your account and which medical
expenses you will use the funds to pay. When you
change jobs or move, the account remains intact.
Any unspent balances remain in your account
earning interest until you spend them on medical
care.
An HSA can be a comforting
safety net if you have a high deductible plan
(remember, your plan won’t begin paying out
until your financial responsibility is met). In
the event that you lose a job, must seek
uncovered medical services or just want to
exercise your right to seek a specialist not
contracted with your insurance plan, the funds
in an HSA may one day be your saving grace. If
you are a consumer who desires security and
values freedom, an HSA is an option you should
research.
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Dental Insurance
refers to a contract in which a consumer pays
premium in return for contracted dental
services. Consumers may choose a plan which
offers discounts on specified dental services
performed by providers that are contracted with
the organization. Many consumers simply receive
dental service benefits as part of a larger
healthcare insurance policy.
Request a FREE dental discount quote
online >>
Consumers can chose a plan in
which their dental care is managed by a Dental
Health Maintenance Organization (DHMO). DHMOs
typically charge the lowest premiums and provide
the most comprehensive coverage. Fee for
service, or Direct Reimbursement, plans provide
the most freedom of choice for consumers. With
this type of plan a patients may pick any dental
practitioner and clinic of their choosing. The
plan pays a percentage for the service and the
patient pays the remainder of the fee.
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Indemnity Health Insurance:
What is it and What Does it Cover?
Indemnity health insurance plans, also know as “fee-for-service” plans,
are designed to allow patients maximum flexibility and choice when it
comes to their providers. With an indemnity health insurance plan, you
can choose which doctor and hospital you visit without worrying about
in-network or out-of-network providers.
Some indemnity health plans do not cover preventative care visits (such
as yearly check-ups with your physician). Under these plans, the fees
paid toward these services will not count toward your deductible.
Request a free health insurance quote now >>
Is an Indemnity Health Insurance Policy Right For Me?
If you are looking for an extremely flexible plan that will allow you to
choose any provider that you want, then an indemnity health plan may be
for you.
Who is eligible for Indemnity Health Insurance?
Indemnity health plans do not require any special eligibility
qualifications. Insurers will base your eligibility on your medical
history and current health, just as with a regular HMO or PPO plan.
What does an Indemnity Health Insurance Policy cost?
Indemnity health insurance plans are generally more expensive that an
HMO or PPO plan, however, many patients feel that the flexibility in
choosing your own provider is worth the added cost.
Indemnity health plans are often offered as deductible health care
plans. Once your deductible amount is reached, you may be required to
pay a co-pay ( a percentage of the medical service fee), and the
insurance policy will cover the rest.
Ready for a health insurance quote?
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Are there other options similar to Indemnity Health Insurance?
While no other type of plan offers the range of choices that indemnity
health plans do, you may be able to find another plan that offers
similar options that interest you. If you are looking for a high
deductible plan, a catastrophic health plan may provide the coverage you
are looking for. If you would like a greater provider selection, you may
opt for a PPO plan which allows you to choose an out-of-network
physician.
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The Consolidated Omnibus Budget Reconciliation Act
(COBRA) is a federally protected law that was created to provide covered
employees and their immediate families with temporary continued access
to employer sponsored group health insurance benefits when such access
will otherwise be terminated. For many, COBRA is a viable option when
they are put in this situation.
For others, the expense and impermanent nature of COBRA make for an
un-wanted temporary solution, and they find that individual health
policies or short term health insurance plans work best. In order to
determine if COBRA is right for you, it is important to fully understand
what COBRA offers. Once you have an understanding of how COBRA works,
compare your other options to find what best suits your medical and
financial needs.
Find out how you can save by requesting a free no obligation health
insurance quote today>>
Eligibility
COBRA was designed to provide temporary continuing coverage for
employees, their spouses, ex-spouses, and dependant children. It does
not apply to everyone though, as eligibility is reliant on limited
conditions. You may be eligible for a COBRA plan if you are currently or
were recently (within 60 days of leaving the workplace) employed by a
company that had more than 20 employees and offered group health
insurance at the time of the qualifying event. A qualifying event for a
COBRA plan is one in which the life or employment situation of an
individual changes in a way that causes an individual's coverage to be
terminated. These events include:
Termination of employment (death, retirement, dismissal, resignation)
Reduction of working hours
Divorce (spouse)
Loss of ¨dependent¨ status (child)
If you are un-certain about your eligibility for COBRA and want to make
sure you and your family are covered, you should also explore individual
health plan options.
Explore your options now—request a health plan quote today >>
Coverage
The COBRA plan offers health coverage to a terminated employee for a
maximum of 18 months, sometimes less depending on how you qualify for
the plan, and the family of an employee for up to 36 months, offering
the same benefits as the initial group health care policy. It is
important to note that COBRA only covers medical insurance, and does not
include life insurance or disability coverage. The following are some of
the benefits offered by a COBRA health plan:
Inpatient and outpatient hospital care
Physician care
Surgery
Prescription drugs
Other medical benefits, such as dental and vision care
Though COBRA coverage offers many of the same functions as individual
and family health plans, they are often more costly so make sure to
compare your options before committing to a COBRA plan.
Request a no obligation health insurance quote today >>
Cost
COBRA fees will vary based on the health plan you previously had with
your employer. While employed, health insurance is usually subsidized by
employers and workers are only responsible for paying a portion of their
premium. With a COBRA plan, however, individuals are accountable for the
entire premium plus a 2% administrative fee. If you wait to commit to a
COBRA plan until the end of the 60 day allowance period, you may be
required to pay retroactive fees. If you fail to make a payment, your
COBRA plan may be terminated.
Disadvantages
Although, COBRA is a great option for some people, it has a number of
disadvantages that make it unacceptable for others, such as its
provisional nature. It is necessary to remember that COBRA offers only a
temporary fix to a life-long problem—if you are looking for a long-term
health insurance solution, COBRA is not for you. Furthermore, many find
the costs associated with COBRA to be quite high. If you are used to
your employer paying a percentage of your premium, you may be in for a
rude-awakening.
With a COBRA plan, you are required to pay 100% of your premium in
addition to a 2% administrative fee. As the payment is no longer
deducted from your paycheck, make sure to take into account that your
payments are now from post-tax dollars. Typically your cost will never
exceed 102% of your premium, but in rare instances you may be required
to pay 150% of what you where paying while employed. If your insurance
needs are covered by what COBRA offers, and you are willing to afford
the higher cost, COBRA may be right for you.
COBRA plans offer a wide range of coverage options, but in the end they
can be much more expensive than what you are used to. You may want to
consider other options like individual or short term insurance plans. In
any case, it is a good idea to learn about the many potential health
insurance providers and options available in order to find the most
suitable plan for you.
Compare your health insurance options.
Get a health insurance quote >>
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Vision insurance
refers to a contract between a consumer and an
insurance organization which provides vision
care in return for a premium. In exchange for
their premium payments, consumers usually
receive eye examinations (given by doctors and
clinics contracted with the insurance
organization) and corrective eyewear. Exactly
how much of the fees are covered varies
according to the specifics of the plan.
Even if you have perfect vision,
proper preventative eye care is an essential
practice towards ensuring the health of your
vision in the years to come . The most important
step is receiving routine examinations from a
qualified eye care professional. Individuals
between the ages of 20 to 40 are recommended an
exam every 5 years or so, provided no visual
changes or injury has occurred. Individuals over
the age of 40 should have an exam every 2 years
or so.
Plan features and benefits will
vary depending on the provider, but features
typically discounted include:
- Eye examinations
- Surgical procedures -
including Lasik procedures
where available.
- Frames
- Lenses
- Contact Lenses
- Non-prescription sunglasses
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