The benefits for health insurance vary in many ways depending upon the needs of the employer and employees. The following is a summary of the various plans that are available in the health insurance market:
Indemnity Plans |
This plan is the traditional plan where the insured pays a pre-determined deductible and coinsurance. Once the deductible has been met for the year, the insured begins paying the coinsurance. |
Managed Care |
This is the method by which the insurance system balances the costs and quality of health care delivery. Partnerships between health care providers, insurance companies, and consumers help to direct and manage health care. The Preferred Provider Organization (PPO), Health Maintenance Organization (HMO) and Point of Service (POS) are all examples of Managed Care. |
Preferred Provider Organization |
PPOs are networks of doctors, hospitals, and other health care providers that work with specific carriers to provide special benefit programs. You can choose to use PPO or non-PPO providers whenever medical attention is needed. The choice is yours ... by utilizing the network you can maximize your benefits and minimize your out-of-pocket costs. |
Health Maintenance Organization |
When you join an HMO each member selects a physician from the network to be your primary care physician (PCP). Your PCP is responsible for coordinating all your medical care, either personally by referring you to participating specialists, or arranging for hospital care. HMOs offer low and predictable costs with no deductibles to satisfy and only a small co-payment at the time of service. |
Point of Service Plans |
POS, the new generation of managed care products, combines the very best of an HMO and a PPO. As a member of a POS, employees receive access to a select group of hospitals and physicians who have agreed to provide quality service at reduced fees. Like the HMO, each member selects a Primary Care Physician who acts as a gatekeeper to direct medical care and ensure that benefits are used properly. Like a PPO, POS allows the employee to choose between participating or non-participating providers at the point of service. Benefits for out-of-network are paid at a lower rate than for in-network benefits. |
