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


  • Comment Link JamesFus Wednesday, 18 October 2017 10:37 posted by JamesFus

    free adult cam chat free sex chat cams found it for you [url=]two way webcam sex chat[/url]

  • Comment Link JamesFus Wednesday, 18 October 2017 08:35 posted by JamesFus

    essay writing service essays writing services essay writing service [url=]essay writing service[/url]

  • Comment Link JamesFus Tuesday, 17 October 2017 17:23 posted by JamesFus

    direct payday lenders payday loan online loans online [url=]payday loans online[/url]

  • Comment Link JamesFus Tuesday, 17 October 2017 07:29 posted by JamesFus

    paper writer write my essay write my thesis [url=]buy an essay[/url]

  • Comment Link BernardViork Monday, 16 October 2017 21:25 posted by BernardViork

    order generic cialis in canada
    tadalafil generic
    order brand cialis online
    [url=]cialis on line[/url]
    cheap cialis in australia

  • Comment Link Fdcbchali Monday, 16 October 2017 18:36 posted by Fdcbchali

    Many thanks extremely practical. Will share site with my friends.

  • Comment Link JamesFus Monday, 16 October 2017 16:50 posted by JamesFus

    website Learn More Here Home Page [url=]Your Domain Name[/url]

  • Comment Link Lvzbrurry Monday, 16 October 2017 07:18 posted by Lvzbrurry

    Regards for sharing your superb site.

  • Comment Link XRumerTest Wednesday, 19 August 2015 01:25 posted by XRumerTest


  • Comment Link vabzpsdf01 Friday, 23 January 2015 08:57 posted by vabzpsdf01

    Best gucci handbags,gucci outlet,gucci outlet online,cheap gucci handbags,gucci handbags outlet,gucci online store,cheap gucci outlet,gucci handbags 2014,gucci handbags outlet store,2014 gucci handbags,prada handbags,prada outlet,prada handbags outlet,prada outlet online,prada outlet store,prada online store,chanel handbags,chanel outlet,chanel bags,kate spade outlet,kate spade handbags,kate spade handbags outlet,kate spade outlet online,chi hair straightener,chi flat irons,chi straightener,chi flat iron sale,chi flat iron,chi flat iron on sale,toms outlet,toms shoes outlet,toms shoes outlet online,toms shoes 2014,toms shoes outlet stores,toms outlet store,toms outlet online,jimmy choo shoes,jimmy choo outlet,jimmy choo sale,jimmy choo shoes women,jimmy choo shoes sale,jimmy choo wedding shoes,jimmy choo sandals,tommy hilfiger outlet stores,hilfiger,tommy hilfiger company stores,hollister clothing,hollister clothing store,hollister outlet,abercrombie and fitch outlet,abercrombie outlet,abercrombie fitch outlet,hollister women,hollister men,hollister clothing store,hollister clothing,hollister clothing store,hollister store,hollister jeans,hollister shirts,hollister shorts,hollister clothing,abercrombie fitch,abercrombie outlet,abercrombie fitch outlet,abercrombie fitch clothing,hollister women,hollister men,hollister clothing,hollister clothing store,hollister outlet,calvin klein women,calvin klein women underwear,calvin klein underwear women,women calvin klein,calvin klein womens underwear,calvin klein underwear for women,cheap calvin klein underwear,calvin klein underwear outlet,calvin klein underwear sale,calvin klein underwear,calvin klein outlet,calvin klein outlet online,calvin klein boxers sale,cheap calvin klein boxers,calvin klein boxers for men,calvin klein boxers,calvin klein briefs,calvin klein boxer briefs,boxer calvin klein,calvin klein outlet,calvin klein outlet online,calvin klein underwear,calvin klein outlet stores,calvin klein underwear sale,calvin klein underwear outlet,calvin klein underwear men,calvin klein men,calvin klein men underwear,calvin klein underwear for men,men calvin klein,mens calvin klein underwear,discount watch,discount watches,discount watch store,rolex knockoff watches,discount watches online,knock off watches,fake rolex,fake rolex watches,fake rolex watches sale,fake watches,fake rolex watches for sale,fake rolex watches for men,cheap men watches,cheap watches women,cheap rolex,imitation rolex watches,cheap watches,cheap rolex watches,cheap watches men,cheap replica rolex watches,replica rolex,replica rolex watches,rolex replica watches,swiss replica watches,rolex replica,swiss replica rolex watches,rolex watches replica,rolex replica watch for sale,rolex replica,

<< Start < Prev 1 2 Next > End >>

Leave a comment