The purpose of getting a health benefit plan is to protect you from the alarming cost of medical care by providing you with insurance coverage for specified health and medical care services. Generally, you will pay a monthly premium, a deductible, and co-payments for services you receive. The cost of insurance is significantly less than if you had to pay for medical care out of your pocket. There are three basic types of health insurance, the fee for service, consumer-directed, and managed care. These basic types of insurance plans cover hospital, medical, and surgical expenses, and depending on the particular plan you choose, possibly prescription drugs, mental/behavioral care, and dental.
A fee for service plan means the health care professional you choose will be paid a fee for each service provided to you. You can choose your doctor and the insurance claim can be filed by either the doctor or the patient. A managed care plan will provide coverage to their members and offers incentives for patients who choose doctors participating in the plan’s network. The 3 types of managed care plans are HMOs, PPOs, and POS plans.
An HMO allows you to receive medical care through a network of participating physicians. You will generally select a primary care doctor, who will then refer you to a specialist when necessary. A PPO combines various features of an HMO and a fee for service plan. Members can choose from network doctors and pay lower upfront expenses, or choose any doctor they desire and pay more out of pocket expenses. A consumer-directed health plan gives members more choices and options in making health care decisions. Consumer-directed plans include a health account or fund designated for health care expenses. At the end of each year, unused funds will roll over to the next year.
A health benefit plan premium is a fee paid to the insurer to purchase health coverage. Premiums can be paid monthly, quarterly, or annually. Deductibles are the amount you will pay for covered services within a certain time frame, according to the terms of your plan, before you will be entitled to insurance benefits. Members with a high deductible may have to pay the first one thousand dollars of yearly medical expenses before the insurance would begin to pay, and those with a higher or lower deductible would pay more or less, depending on the particular amounts specified in their plan. A co-payment is a stated amount or percentage that must be paid by the member along with each doctor’s visit, medical procedure, or prescription. For example, if your specified co-payments are $25, you will pay the first $25 of each doctor visit and your insurance would cover additional charges. Most insurance plans specify a different co-payment amount for prescriptions, doctor visits, and hospital or surgical care.
In choosing which type of health benefit plan is right for you, you must consider the affordability of doctor visits and hospital care, the amount of the monthly premium, the amount of the deductibles, and the amount of the co-payments. Make sure the plan you chose offers coverage for services you will use such as doctors, prescriptions, laboratory costs, treatment for preexisting conditions, and out-of-network care. Check the rating of the insurance company in question, the number of patient complaints in the past year, doctor drop out rates if the insurance plan includes a network and the number of members who have dropped out of the plan in the past year. A health benefit plan that is subsidized by your employer is generally the least expensive, but if your employer does not offer health insurance, you should consider an individual health benefit plan. The cost of medical care is far too expensive to risk not having health insurance.