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HEALTH INSURANCE
Individual And Family Health Insurance:
Individual and family
health insurance is a type of health
insurance coverage that is made available to individuals and families,
rather than to employer groups or organizations. Given the option, most
people would prefer to have their employer provide group
health insurance coverage. But, if this is not an option for you,
it is still important for you to seek coverage. You may be pleasantly
surprised with the variety and affordability of the individual and family
health insurance options available.
Types of individual and family insurance
Individual and family health
insurance plans are usually described as either "indemnity"
or "managed-care" plans. Put broadly, the major differences
concern choice of healthcare providers, out-of-pocket costs and how bills
are paid. Typically, protection plans offer a broader selection of healthcare
providers than managed care plans. Indemnity plans pay their carve up
of the costs for enclosed services only after they receive a bill. There
are several diverse types of managed-care health insurance plans. These
include HMO, PPO, and POS plans. Managed-care plans typically make use
of healthcare provider networks. Healthcare
providers within a network agree to perform services for managed-care
plan patients at pre-negotiated rates and will usually submit the claim
to the insurance company for you. In general, you'll have less paperwork
and lower out-of-pocket costs with a managed care fitness insurance plan
and a broader choice of healthcare providers with an indemnity plan.
How does a PPO plan work?
As a member of a PPO (Preferred Provider Organization)
plan, you'll be confident to use the insurance company's network of preferred
doctors and hospitals. These healthcare providers have been fined to provide
services to the health
insurance plan's members at a economical rate. You typically won't
be required to pick a primary care physician but will be able to see doctors
and specialists within the network at your own discretion.
You will almost certainly have an annual deductible to pay before the
insurance company starts cover your medical bills. You may also have a
co-payment for certain services or be mandatory to cover a certain percentage
of the total charges for your medical bills. With a PPO plan, Services
rendered by an out-of-network physician are characteristically covered
at a lower percentage than services rendered by a network physician.
How does an HMO plan work?
Though there are many variations, HMO (Health Maintenance
Organizations) plans typically enable members to have lower out-of-pocket
healthcare expenses but also offer less flexibility in the choice of physicians
or hospital than other health insurance plans. As a member of an HMO,
you'll be required to choose a primary care physician (PCP). Your PCP
will take care of most of your healthcare needs. Before you can see a
specialist, you'll need to obtain a referral from your PCP.
With an HMO you'll likely have coverage for a broader range of preventive
healthcare services than you would through another type of plan.You may
not be required to pay a deductible before coverage starts and your co-payments
will likely be minimal. With an HMO plan, you typically won't have to
submit any of your own claims to the insurance company. However, keep
in mind that you'll likely have no coverage whatsoever for services rendered
by non-network providers or for services rendered without a proper transfer
from your PCP.
What is a co-payment?
A "co-payment" or "co-pay" is a specific
charge that your health
insurance plan may require that you pay for a specific medical service
or supply. For example, your health insurance plan may require a $15 co-payment
for an office visit or brand-name prescription drug, after which the insurance
company often pays the remainder of the charges.
What is a deductible?
A "deductible" is a specific dollar
amount that your health insurance
company may require that you pay out-of-pocket each year before your health
insurance plan begins to make payments for claims. Not all health insurance
plans require a deductible. As a general rule (though there are many exceptions),
HMO plans typically do not require a deductible, while most Indemnity
and PPO plans do.
What is coinsurance?
Coinsurance is the term used by health insurance
companies to refer to the amount that you are required to pay for a medical
claim, apart from any co-payments or deductible. For example, if your
health insurance plan has a 20% coinsurance requirement, then a $100 medical
bill would cost you $20, and the insurance company would pay the remaining
$80.
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