TYPES OF HEALTH INSURANCE PLANS
There are a variety of health insurance plans to choose from, they include;
Managed Care Plans
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.
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 Maintenance 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.
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.