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Individual and Group health
insurance plans provide long-term protection and comprehensive medical
coverage for you and your family.
Several different types of plans
are:
Health Maintenance
Organization (HMO) is a type of health care plan that provides
managed care. This plan has specific rules that patients and doctors
have to follow. When you join an HMO, you are usually required to choose
a primary care provider (PCP) doctor. Your PCP has the overall
responsibility for helping you stay healthy. Some HMOs require you
receive a referral from your primary care provider if you want to see a
specialist. To control costs, HMOs set limits on the range of treatments
available to members. Except in cases of emergency, most HMOs pay for
treatment only if it is provided by doctors and hospitals that belong to
the HMO's network.
Preferred Provider
Organization (PPO) offers members greater flexibility in choosing
treatment. With a PPO, you can use any doctor or hospital on a list of
preferred providers. If you want to receive treatment elsewhere, the PPO
will pay a portion of the cost. Some PPOs do not require you to choose a
primary care provider, and you do not need a referral to see a
specialist. Because PPOs have fewer restrictions on treatment than HMOs,
they usually have higher premiums.
Major Medical Insurance
(sometimes referred to as traditional health insurance) provides
coverage for most types of medical treatment. Your options are not
limited to certain doctors or hospitals. Some major medical plans have a
deductible, followed by a co-insurance percentage (i.e. 80/20). You pay
a certain amount for medical treatment each year out of your own pocket
before the plan starts to pay for your care. Major medical plans have
fewer restrictions than HMOs and PPOs, so they usually have higher
premiums.
Point-of-Service (POS)
plans are similar to HMOs and PPOs. Like an HMO, a POS plan requires you
choose a primary care provider (PCP) who will have overall
responsibility for your care. You might need a referral from your
primary care provider to see a specialist. If you see a specialist in
the POS network, you pay no deductible and only a small co-payment. A
POS plan gives you the option to see a physician or hospital outside the
network; however the plan only pays part of the expense. A POS plan has
fewer restrictions than an HMO, but it does not provide as much
flexibility as a PPO.
Supplemental Insurance/ Gap
Plans provide benefits in addition to those you receive from your
group health plan. For example, a supplemental insurance plan would pay
you a certain amount every day you’re hospitalized or disabled, which is
generally used to offset the out of pocket cost for paying a high
deductible. This payment is in addition to coverage you have under your
current health care plan
Guaranteed Issue / Mini Med
Plans provide health care benefits to individuals that do not
qualify for a health insurance policy because they have pre-existing
health conditions (cancer, diabetes, heart conditions, depression, etc.)
that disqualify them. A guaranteed issue health policy will offer
comprehensive health insurance coverage to people in such a predicament.
These plans come with benefit limitations and usually come in a variety
of price brackets. Some companies offer a deductible program, and
others offer a co-pay plan.
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