Types Of Health Insurance Plans
There are a variety of health plans to choose from,
they include;
- Managed Care Plans
- Fee-of-Service Plans
- Health Maintenance Organizations (HMOs)
Plans
- Point-of-Service Plans &
- Preferred Provider Organizations (PPOs)
Plans
Managed Care Plan
Managed Care plans help insurers to control
costs. Here the insurance companies sign an
agreement with doctors and hospitals to provide
health care services for their members. In a
managed health care plan, you choose to visit
doctors and hospitals from the insurance company’s
network list of hospitals and specialists. If
you want to see a doctor outside your plan,
you will have to pay more. Most people get their
managed care health insurance through their
jobs. Here the employer pays the managed care
plan a fixed amount of money in advance to pay
for all your health care needs. You pay only
a small amount.
Fee-Of-Service Plan
In a Fee-of-Service plan, the insurance company
pays part of your doctors and hospital bills,
while you pay a monthly premium fee. This is
a traditional form of health care. Here the
insurance company basically pays fees for the
services provided to the insured people covered
by the policy. With this type of health plan
you get the best choice of doctors and hospitals.
To receive a claim for a fee-of-service plan
you have to fill out forms and then send them
to your insurance company. You also need to
keeps receipts and bills for your medication
and other medical costs. In this plan you are
basically responsible for keeping a track of
your own medical expenses.
There are two kinds of fee-of-service coverage’s
- basic and major medical. Basic coverage covers
the cost of the hospital room and care while
you are at the hospital. It also covers some
hospital services and supplies, such as x-rays
and prescription medications. Basic coverage
also extends towards the cost of surgery, whether
it is preformed in or out of the hospital and
for some doctors visits. Major medical coverage
on the other hand covers the cost of long term,
high cost illness or injuries.
Health Maintainance
Organizations (HMOs) Plans
An HMO plan is a pre-paid health plan, where
you pay a monthly premium. This plan provides
comprehensive care, including doctor’s
visits, hospital stays, emergency care, surgery,
lab tests, x-rays and even therapy if needed.
Under this plan, your choice of doctors and
hospitals is limited to the doctors and hospitals
under contract with the insurance company. However,
in the case of medical emergencies exceptions
are made. As HMOs receive a fixed monthly fee,
they make sure that you get basic health care
for any injury or illness before it becomes
serious. HMOs also provide preventative care
such as regular doctors’ visits, immunizations,
well-baby checkups, mammograms, and physicals,
plus other services such as outpatient mental
health care, which is provided only on a limited
basis. Most people like to use HMO plans as
they do not require the filing of any claim
forms for hospital visits or stays. Members
of the plan simply pay via a membership card.
In nearly all HMO plans, you are either assigned
or you choose a doctor to serve as your primary
care physician. This doctor monitors your health
and provides most of your medical care, referring
you to specialists as and when needed. You usually
cannot see a specialist without a referral from
your primary care doctor; this is why HMO plans
can limit your choice of physicians.
Point-Of-Service Plans
Many HMO plans also offer a Point-of-Service
plan. Here the primary care doctor mainly refers
you to other providers in the plan, but you
also have a choice of being referred outside
the plan, and can still get some insurance coverage.
This means that if a doctor refers you to another
specialist outside the insurer’s network,
the plan will pay most or at least part of the
bill.
Preferred Provider
Organizations (PPOs) Plans
The PPO plan is a combination of a fee-of-service
plan and an HMO plan. Here, you have a limited
number of doctors and hospitals to choose from;
however, when you do visit the doctor, you pay
by membership card like in the HMO plan. With
this plan most of your bills are paid if you
go to your network provided doctor. The PPO
plan is similar to an HMO plan because the PPO
plan also requires you to choose a primary health
care provider to monitor your health. Most PPO
plans also receive preventative health care.
You are allowed to visit a doctor outside your
PPO plan, but you will have to pay a larger
portion of bill, while the insurance company
only covers a small part. |
