There
are numerous plans, coverages and options you can tailor to
your needs. The sections below outline the common Types of
Policies and Policy Options. It's a good idea to work with
an agent to help you create a benefits package that's right
for you and your employees. When you are finished reading this
section, use our search form on the right of the page to request
a quote from an experienced agent.
Types
of Policies
Each plan differs in coverage, payment terms and medical treatment procedures
(i.e. available doctors). Below is a list of common policies:
Indemnity
(Fee-for-service): allows you to go to any hospital or
doctor. You submit a claim and pay the invoice (to be reimbursed
later) or authorize the hospital or doctor to collect their
fees directly from your insurance company. Although this plan
is very flexible in who provides your care, the premiums are
higher than other types of health insurance. Also, indemnity
plans usually do not provide any coverage until the deductible
has been satisfied.
PPO
(Preferred Provider Organization): the insurance company
has a network of "preferred providers" (hospitals,
doctors, clinics, etc.). These providers discount their service
fees to your insurance company in exchange for being part of
the network. If you use a provider from outside the network,
you'll have to submit a claim and likely pay a higher deductible.
This is usually cheaper but not as flexible as the indemnity
plan.
HMO
(Health Maintenance Organization): all your medical services
are provided by the organization of doctors, hospitals, etc.
The HMO is much like a strict PPO: you must use the
providers they authorize (except for emergencies as defined
by your plan). Your doctor refers you to other doctors within
the HMO as necessary. The HMO's advantage is that it has no
deductibles and usually requires only a small co-payment for
each service. There may also be a maximum to what you pay annually "out-of-pocket."
POS
(Point-Of-Service): this is an option of HMO with greater
flexibility. Your primary doctor may refer you to someone outside
of the HMO with minimal or no additional cost. You may also
refer yourself to a non-HMO provider, but you'll have to pay
co-insurance.
Common
Options
After
all is said and done in selecting the plan and establishing its
terms, your agent will give you a proposal. The Proposal contains
five key areas:
Doctor
Co-Pay: like HMO's, Indemnity and PPO plans may offer doctor
co-payment options. A small fee is paid to the insurance company
($10-$40) for each visit to the doctor. This usually isn't
subject to deductibles and co-insurance.
Prescription
Card: the card enables your insurance carrier to pay most
of your prescription costs. Usually presented at the drugstore,
you'll pay only a fraction what it normally costs depending
on your policy and type of prescription (i.e. brand name or
generic).
Accident
Supplement (AS): in case of an accident, this option would
pay for any medical treatment up to the predetermined amount
without a deductible. Any costs in excess would then have deductibles
and co-payment apply as normal.
Preventive
Care: some policies may offer this as either an option
or an inclusion. Routine physicals, immunizations, and tests
may be covered without a deductible.
Vision: your
carrier may include visual benefits, ranging from co-payment
eye exams and discounted glasses.
Dental: general
cleaning and other basic dental care. |