Insurance FAQ 
Q.
What are the sources of Health Insurance?
A. Health insurance is generally available
through groups and to individuals. When you receive group insurance
at work, the premium usually is paid through your employer. For
individual insurance, it is best to contact a professional health
insurance agent to review your options.
Q. What are the types of Health Insurance
Plans?
A. Health insurance plans are usually
described as either indemnity (fee-for-service) or managed care.
Indemnity and managed care plans differ in their basic
approach. Put broadly, the major differences concern choice of
providers, out-of-pocket costs for covered services, and how bills
are paid. Usually, indemnity plans offer more choices of doctors
(including specialists, such as cardiologists and surgeons),
hospitals, and other health care providers than managed care plans.
Indemnity plans pay their share of the costs of a service only after
they receive a bill.
Besides indemnity plans, there are basically three types of
managed care plans: PPOs, HMOs, and POS plans.
Q. What is an Indemnity Plan?
A. Also known as traditional or
fee-for-service plans, indemity plans allow you to choose any doctor
or hospital you want. In return, you pay an annual deductible, then
a percentage of your medical bill. Although these plans offer the
greatest freedom to select any doctor, they are usually the most
expensive option available.
Q. What are the kinds of Managed
Care?
A. Preferred Provider Organization
(PPO). Each time you need care, you choose among doctors who
belong to the PPO network or any non-network doctor. If you go to a
doctor within the PPO network, you will pay a copayment. Your
coinsurance will be based on lower charges for PPO
members.
Health Maintenance Organization (HMO). HMOs require
that you pay a small, set copayment when you use the plan's HMO
doctors. You generally don't have to pay a deductible in an HMO. You
usually select a primary care physician who manages all of your
health care and serves as a gatekeeper for specialty
care.
Point-of-Service (POS) Plan. Many HMOs offer an
indemnity-type option known as a POS plan. POS plans or Open Access
HMOs add an out-of-network benefit to HMOs. Like HMOs, you select a
primary care physician who manages all of your care and is
responsible for referring you to plan specialists. In a POS plan
however, you have the option of going outside the HMO
network.
Q. What should I look for when choosing a
Health Plan?
A. Whether you end up choosing an indemnity
plan, PPO, POS, or HMO plan, there are a number of important things
to consider in choosing the right one. These include: services
offered, choice of providers, location, costs, and quality of care.
Q. What should I look for when choosing a
doctor?
A. In some managed care plans, you will
generally be limited to choosing from only certain doctors; in other
plans, some doctors may be "preferred," which means they are part of
a network and you will pay less if you use them. Ask your plan for a
list or directory of providers. The plan may also offer other help
in choosing.
You can ask doctors you know, medical societies, friends,
family, and coworkers to recommend doctors. You may also contact
hospitals and referral services about doctors in your
area.
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