Hcr230

There are many different types of medical insurance plans available to consumers and employers today. With all the varieties there are some unique differences in the policy types as well as similarities. Each type of plan has its own set of both provider and policy holder agreements, different cover ages, costs, and allowances. • PPO – Stands for Preferred Provider Organization insurance. Doctors, pharmacies, hospitals etc. must be a member with the PPO and agree to accept their discounted payments to be considered a “in network” provider by signing a contract with the PPO. Patients under this plan are required to pay both premiums as well as co-payments. One of the big advantages of this plan is that a policy holder has the choice of going to a provider “in Network” will set financial amounts or to an “out of network” doctor but will be charged a higher co-payment and receive les in coverage paid by the PPO. • HMO - Health Maintenance Organizations is the name of this plan and it has the strictest guidelines and offers the least amount of providers for the policy holder to choose from. This type of insurance puts emphasis on and provides coverage for preventative medicine and disease management medicine. Policy holders are only obligated to pay a co-pay amount for services after paying their annual premium. This insurance is licensed by the state. • Group HMO – A group of doctors are reimbursed for their services under this plan on a pre-negotiated amount. Many group HMO’s will also contract with hospitals so their group physicians can provide care within their facility. • IPA - Independent Practice Association Model. This is a type of HMO that has been created by a group of doctors with separate practices, which agree to provide care for an HMO through a contract between themselves, the other physicians and the HMO. • POS - Point-of-Service Plan. This type of plan is a combination of an HMO and a PPO. • Indemnity – This type of plan normally has high deductibles that must be paid by the policy holder. They cover on average around 70 – 80 percent of the medical cost after the premium and deductible is paid and met. • CDHP - Consumer-Driven Health Plans. This plan is made up of a high deductible and one or more medical savings accounts. • Health Reimbursement Account – This plan is both created and funded by the employer of the policy holder. Many companies that offer a type of insurance that had high deductibles or premiums will offer this to their employees so they can be reimbursed for covered medical expenses that they pay for on their own. • Flexible Savings Account – This is funded solely by the employee with money amounts they opt to pay into account before taxes from their pay check. This can be accessed in one of two ways; by submitting receipts or bills for reimbursement to the employer, or by a credit or debit card provided. Any employee participating in this type of account must remember the “use it or lose it” rule when having this account. If funds remain and they go back to the employer not the employee.