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 Posted: Tue Jul 04, 2006 10:30 am Post subject: Types of health insurance and how it works |
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Different types of health insurance plans are available in US. But one needs to choose a plan according to the budget, needs and lifestyle. Also it is necessary to become aware of the regulations of the state or the federal agency. Almost every policy has its own advantages and disadvantages. The policies available are:
• Indemnity Policies (Traditional Fee-for-Service Insurance)
• Preferred Provider Organizations (PPOs)
• Health Maintenance Organizations (HMOs or Managed Care)
• Multiple Employer Welfare Arrangements (MEWAs)
1. Indemnity Policies (Traditional Fee-for-Service Insurance): Most indemnity policies allow you to choose any hospital or doctor that you wish when seeking health care services. Deductible is available with the indemnity policy. There are choices in the amount of deductible that you pay before policy benefits are provided. Once you pay the deductible amount, the remaining charges are reimbursed as per the policy contract. There is a term called co-payment. It is defined as the difference between eligible charges and the percentage paid. It is specified the terms and conditions of what is covered and what is not covered in the policy or the employee benefit booklet. Ask your agent, insurance company or the employer if you have the queries.
2. Preferred Provider Organizations (PPOs): PPO provides a list of contracted 'preferred' insurance providers from which you have to choose. You can receive the highest monetary benefit if you limit your health care services to those listed providers. If you move to other doctor out of this list you are "out of network" and smaller percentage of health care cost is covered. It is advisable to check with the PPO or consult with the list of preferred providers before you look for health care services.
PPOs are regulated by either the CDI or the Department of Managed Care depending upon whether the underwriting company is a licensed insurance company or a managed care one. Queries related to the PPO can be resolved through the plan documents for regulatory information.
3. Health Maintenance Organizations (HMOs or Managed Care):To get health care services from doctors and hospitals affiliated with the HMO membership is required in a Health Maintenance Organization.
It is common practice in HMOs Membership in a Health Maintenance Organization (HMO) requires plan members to obtain their health care services from doctors and hospitals affiliated with the HMO. It is common practice in HMOs for the plan member to choose a primary care physician who treats and directs health care decisions and who coordinates referrals to specialties within the HMO network. The doctors and hospital personnel may be employees of the HMO or contracted providers. Since HMOs operate in restricted geographic regions, this may limit coverage for plan members if medical treatment is obtained outside the HMO network or coverage area. The intent of managed care products is to create less costly delivery of health care services while maintaining quality health care by specifying provider choice.
HMOs offer access to a comprehensive package of covered health care services in return for a prepaid monthly amount (premium). Most HMOs charge a small co-payment depending upon the type of service provided.
4. Multiple Employer Welfare Arrangements (MEWA):MEWA can be described as an employee benefit plan covered by the Employee Retirement Income Security Act (ERISA). And so it is exempted from the State insurance regulation under ERISA's broad preemption requirements but they are regulated by the Department of Labor under the Employee Retirement Income Security Act.
By avoiding state insurance reserve, contribution and other requirements applicable to insurance companies, MEWAs are often able to market insurance coverage at rates substantially below those of regulated insurance companies, thus, in concept, making the
MEWA is an attractive alternative for the small businesses those who find it difficult to obtain an affordable health care coverage for their employees. The reason behind this is that, MEWA is often able to provide the market insurance coverage at a much lower rate as compared to the regulated companies. |
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sasha
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| Posted: Fri Jul 07, 2006 5:28 am Post subject: Self-Insured Health Plans: |
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Hi Sasha... good article indeed. But you have perhaps missed another health insurance plan i.e the Self-Insured Health Plan. Let me explain the whole in a brief.
The self-insured employer-sponsored plans do prove to be more useful in terms of their health insurance benefits towards employees because of their nature. In order to keep a track of the premiums, claims and associated documentation, the self funded employers generally appoint a third party administrator. A number of these insurance companies would prefer to go into a contract with the employers posing as TPAs. In such a case, the facts related to a plan would be kept a secret since the plan is self funded.
The benefits handbook and the claims forms would depict the names of the TPA as well as the employer posing the TPA as the original insurer. A self funded employer designs the benefits and also takes a call as to which claims should be paid. The employer's instructions are to be followed by the TPA for that instance.
Hope the other members too would add to the types of health insurance list. |
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brian
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| Posted: Fri Jul 14, 2006 2:37 pm Post subject: Types of health insurance plan-HSA |
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| How do you all feel about the HSA. Health Savings Accounts, I find small employers like this option. |
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RickBlaine
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| Posted: Fri Jul 14, 2006 2:44 pm Post subject: |
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if you are not NAA you are being rip off. Join us.
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Register Now to have your Insurance queries solved. |
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Guest
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| Posted: Fri Jul 14, 2006 3:25 pm Post subject: |
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NAA is absolutely the bottom of the barrel agency. Their main product, "Home Certain" of F&G or Old Mutual is absolutely ridiculous. If someone needs or wants Term insurance why not buy from a more secured company not a B rated company and save a few bucks (okay lots of bucks) doing so?
NAA, tends to be hard sale type of agency that plays on emotions of the client not common sense and reality. If you go with NAA ask your recruiter that promises you how easy it is to make money for his or her commission statement or end of year 1099. Make them prove it, they can not prove their claims of potential money to be made, due to various reasons.
You want to talk about the reasons mister NAA? |
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RickBlaine
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| Posted: Fri Jul 14, 2006 3:46 pm Post subject: |
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What Is Most Important to You in a Health Insurance Plan?
In choosing a health insurance plan, you have to decide what is most important to you. All plans have tradeoffs. Ask yourself these questions:
How comprehensive do you want coverage of health care services to be?
How do you feel about limits on your choice of doctors or hospitals?
How do you feel about a primary care doctor referring you to specialists for additional care?
How convenient does your care need to be?
How important is the cost of services?
How much are you willing to spend on health insurance premiums and other health care costs?
How do you feel about keeping receipts and filing claims?
You might also want to think about whether the services that a health insurance plan offers meet your needs. Call the plan for details about coverage if you have questions. Consider:
Life changes you may be thinking about, such as starting a family or retiring.
Chronic health conditions or disabilities that you or family members have.
If you or anyone in your family will need care for the elderly.
Care for family members who travel a lot, attend college, or spend time at two homes. |
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RickBlaine
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| Posted: Fri Jan 23, 2009 11:16 am Post subject: Some other types of health insurance |
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Some other forms of health insurance are,
- High risk insurance and or guaranteed issue plan
- Employment based health insurance
- Government health plan
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bluebell
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| Posted: Fri Jan 23, 2009 11:31 am Post subject: |
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Yeah, the US government also runs several health insurance programs targeted to the old and low income group population.
Medicaid is one such program that is designed to offer medical services and benefits to the financially challenged. It's a Federal program though run by the state government in each state.
Medicare on the other hand is targeted for the elderly population. Americans are entitled to receive Medicare benefits after reaching the age of 65. Medicare is financed through your employment i.e. you contribute to the Medicare program from your income |
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simon
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| Posted: Mon Jan 26, 2009 2:41 pm Post subject: |
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Sasha's original post highlights the common network types insurance plans utilize. Different types of insurance, for example, HDHP(high deductible) or Copay plans utilize these network types. The other thing to remember is who the contract "owner" is, IE the individual or the employer organization. For example you can have:
- A high deductible plan that utilizes a PPO network, and is individual (the insured "owns" the policy and can take it with them from employer to employer). Some employer also offer group based HDHP's which are NOT portable (if you quit, get fired, etc), the policy goes away (unless you opt for COBRA)
- A copay plan that utilizes an HMO network
In short, the 3 main variables are: type of insurance(copay, HDHP, etc), type of network (PPO, HMO, POS), and contract holder/owner (individual, employer). Basically any combination of these 3 is available. "Guarantee issue" refers to the underwriting required to issue the policy. With GI plans, you're "guaranteed" a policy, regardless of medical conditions. It doesn't necessarily indicate a specific type of insurance.
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GuyInGA
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| Posted: Mon Jan 26, 2009 3:00 pm Post subject: |
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| Man this is an old post... |
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dgoldenz
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| Posted: Tue Jan 27, 2009 12:40 pm Post subject: Some other |
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-Health Insurance for Self Employed
-Individual Health Insurance
-Individual Health Insurance Coverage |
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rego
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| Posted: Sat Jan 31, 2009 3:51 am Post subject: |
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| HSA plans are great! |
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insurancebydave
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| Posted: Sat Jan 31, 2009 6:49 pm Post subject: Health Insurance and the Economy |
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| Does anyone have any information on how badly the economy will affect healthcare and/or the types of plans available? |
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BarbaraHall20
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| Posted: Wed Feb 04, 2009 1:42 am Post subject: |
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The types of plan available will basically depend on how much you got for a health plan. Obviously, one can't afford a good but costly insurance, so he might as well enroll in a government funded health insurance. The other plans will still be offered, only that, many will have to buy only what their pockets can take. If the economy continuous to go down, the insurance companies may also cut possible expenses, which could mean lesser coverage in a costly plan.
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shieldon
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