Choosing the right type of coverage, carrier, and plan design can mean the difference in thousands of dollars in premium savings and thousands of dollars in out of pocket, uncovered, medical expenses. We are here to walk you through all of the options available to you and find the right plan in a quick and easy to understand way.
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.
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, indemnity plans offer a broader selection of healthcare providers than managed care plans. Indemnity plans pay their share of the costs for covered services only after they receive a bill (which means that you may have to pay up front and then obtain reimbursement from your health insurance company).
There are several different 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 health insurance plan and a broader choice of healthcare providers with an indemnity plan.
HMO (Health Maintenance Organization)
In an HMO you must select a primary care physician (PCP) who coordinates your medical care with other physicians within an HMO network of providers. Your PCP must refer you to a specialist, except in cases of bona-fide emergencies.
PPO (Preferred Provider Organization)
A PPO plan allows greater patient freedom in choice of health care providers. In this type of plan, a PCP is not required. If you receive care from a preferred provider (someone who participates in the health plan’s network) benefits are paid at a higher level than they would be if the care is rendered by a non-participating provider. Upfront deductibles and coinsurance charges may apply.
High Deductible Health Plan (HSA Compatible)
A High Deductible Health Plan (HDHP) is a requirement for a Health Saving Account (HSA). This type of plan is regulated by the IRS, and specifications change annually. The Health Savings Account is a tax deferred account used to pay for qualified medical expenses.
Group health insurance is employer-sponsored health coverage for business owners, employees and often for dependents.
A majority of Americans have group health coverage through their own or a family member’s employer-sponsored group plan. Employers and employees can share costs, and there are special tax incentives available to businesses that provide group health insurance.
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