Saturday, 28 April 2012 18:49

Explaining Major Medical Coverage

Written by  John Van Dekker
Rate this item
(0 votes)
Health Insurance Policy Health Insurance Policy Feng Yu - Fotolia

Major Medical Coverage plans generally fall into one of two categories; indemnity plans and managed care plans.  Indemnity plans, sometimes called ‘fee-for-service’ plans, generally offer greater flexibility in choice of doctor, hospital and care facility.

Indemnity plans typically require the insured to satisfy a deductible before beginning to pay benefits.

Indemnity plans will often also include a co-insurance component, which means after your deductible is satisfied, your insurer will pay a percentage of your medical expenses (e.g. 80%) and you will be required to pay the remaining percentage (e.g. 20%).

Managed care plans on the other hand generally have agreements with a network of doctors, hospitals and healthcare providers who provide services to members at negotiated rates. Care received from providers whom are not part of this network is often not covered or covered at significantly reduced rates.

 

Indemnity Plans

  • Indemnity Major Medical Plans – generally offer maximum flexibility in where one can seek care. Indemnity plans typically include an annual deductible, which applies prior to the insurance company paying benefits, and co-insurance applicable to expenses up to a certain amount. Indemnity plans will normally determine the amount of benefit payable for a given procedure based on what they consider the ‘Usual and Customary” charge for covered services. This can mean that you can be responsible for a difference in the fee charged by your provider and the amount covered by your insurer under their ‘Usual and Customary” scale.

 

Managed Care Plans

  • Health Maintenance Organization (HMO) plans – usually require that one choose a primary care physician from a network of providers. Specialty care must often require a referral from your primary care physician. Care received outside of the plan’s network will often not be covered or will be covered with significantly lower benefits.
  • Preferred Provider Organization (PPO) plans – are managed care plans which generally include a network of providers with lower negotiated rates, but allow some flexibility for one to seek care outside of the preferred provider network, but with higher deductibles and co-payments.
  • Point of Service (POS) plans – combine some features of HMO as well as PPO plans. Generally one must select a primary care physician. Out of network care is generally covered at a significantly reduced rate or not at all, unless referred to that doctor by one’s primary care physician.
Last modified on Saturday, 28 April 2012 20:53

58 comments

  • Comment Link Buy Essay.Org Monday, 18 December 2017 02:59 posted by Buy Essay.Org

    buying essays online essay essay need help with essay writing

  • Comment Link Paydayloan Monday, 18 December 2017 02:58 posted by Paydayloan

    payday a payday loan small loans no credit check payday

  • Comment Link Online Essays Sunday, 17 December 2017 17:01 posted by Online Essays

    research paper research papers misd homework online research paper

  • Comment Link Premium Assignments Sunday, 17 December 2017 11:11 posted by Premium Assignments

    argument essay argument essay argumentative essay argumentative essay

  • Comment Link Write An Essay Sunday, 17 December 2017 02:08 posted by Write An Essay

    research paper research paper research paper need help with my homework

  • Comment Link Spotloan Sunday, 17 December 2017 01:04 posted by Spotloan

    payday loan online payday payday loans payday loan online

  • Comment Link JamesFus Saturday, 16 December 2017 20:47 posted by JamesFus

    quick personal loans for poor credit quick personal loans quick loans https://quickloans.us.com - fast loans

  • Comment Link Loan Saturday, 16 December 2017 20:18 posted by Loan

    guaranteed payday loans cash advance payday advance loans online payday advance

  • Comment Link College Paper Writer Saturday, 16 December 2017 17:03 posted by College Paper Writer

    holt mcdougal homework help argumentative essays essay writing argument essay

  • Comment Link Ace Homework Saturday, 16 December 2017 14:04 posted by Ace Homework

    order research paper assignment writing help uk essay essay writing

<< Start < Prev 1 2 3 4 5 6 Next > End >>

Leave a comment