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Individual and Family Health Insurance Plan

Individual and Family Health Insurance Plan

How is a “network plan type” described?

The meaning of network plan type is not same for every where; it varies according to the place. But most of the insurers take Preferred Provider Organization (PPO) as a network plan type due to its behavior. It functions under PPO network A PPO plan make a large list consisting preselected healthcare providers at a prenegotiated rates.

How an individual and family health insurance plan is helpful to you?

Individual and family health plan is different from group plan; this plan is entirely prepared for individual or family. If your company does not provide you health coverage then individual or family health insurance plan can help you out.

What are the various types of individual or family insurance plan?

There are three major types of individual and family health insurance plan. First one is indemnity plan, second one is preferred providers organization (PPO) and third one is health maintenance organization (HMO). According to the indemnity plan, a share of the health care cost is paid over the bill from a health care provider. Sometime you have to pay the bill of your provider immediately after you get the services and then wait for the reimbursement from your insurer. You have to do more paperwork in this plan but it provides you with better choice of doctors. In the case of PPO, one has to use the healthcare provider networks. Doctors, physician and other providers in this network are ready to provide services to their patient in prenegotiated rates and the bill receipt has to be submitted to the insurance companies directly. On the other hand, you have to visit a primary doctor before visiting the specialists in their network in HMO.

What are the functions of PPO?

Preferred Providers Organization (PPO) comes under managed care plan. In Preferred Providers organization, a patient is provided with a large list of preselected doctors, physicians or providers ready to give services at prefixed rates. What you have to do is making a small co-payment to the doctors of this network whenever you visit them. If you can afford to pay a higher percentage of the bill, you can go for doctors outside the network.

What are the functions of HMO plans?

According to the health maintenance organization, your out of pocket expenses are lower but still this don’t offer you a greater amount of flexibility like PPO and indemnity plans do. HMO allows you to go for a primary level physician outside the network before you move to the costly specialists in this network. This plan is having control over the physician you choose and services you get but still it provide you with better prices than other plans.

What are the models of HMO?

There are preferably three models of HMO. According to the “staff model”, doctors have to use the HMO staffs as their employees and have to use the HMO buildings as their offices. In the “group model” type, a patient has to pay the bill to the groups of physician directly. And in the case of “network model”, the bill should be paid to the network of groups. This model is the most preferred model.

What is POS and how does it work?

In a POS plan, features of both the PPO and HMO plans are combined together and you have to select a primary care physician from the network of its doctors. You can opt for the out of pocket services, what you have to do is to make a claim for reimbursement which will vary according to the behavior of the plan. It is not very necessary to pay straight for the services you get from the network.

In which way an indemnity plan works?

You have to do a lot of copy work in the indemnity plan which is not required in other health plans. It is very flexible about your choosing of health care providers. You do not need to go for a primary physician; you can go for any doctor. You have to make out of pocket payment for the bill until the deductible is met.

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