An HMO plan only means that you have to use a participating provider, whether it is a doctor, hospital, lab or x-ray facility. We only work with the major insurance companies in each market. Most doctors and hospitals participate with the major insurance companies. HMO’s do not have the same negative perception that they did back in the 80’s. You can now get an HMO that does not require referrals. You will have the freedom to go to a network specialist without a referral on these open access type of HMO plans.
A Point of Service plan is the same as an HMO plan within the network, however , the POS plan will also have an out of network benefit. You will be able to go to any doctor and hospital whether or not they are in the insurance company’s network. To access these out of network benefits you will have a deductible and coinsurance payments. The insurance companies will pay the provider based on usual and customary fees. This is the charge that most of the doctors in the geographical area would charge for the same services. If your doctor charges more you may be required to pay the difference. You can get a POS plan either with or without referrals.
These plans will function very similar to POS plans without referrals. You will have both in and out of network benefits. PPO plans have been considered to be the best form of health insurance, however, they are very expensive. A good POS plan would perform the same as a PPO plan. The member would not experience any major differences.
High Deductible, Consumer Directed Health Plans, Health Savings Accounts (H S A) & Health Reimbursement Accounts (HRA):
These plans are growing in popularity. The policy holder has a high deductible i.e. $1500, $2000 or $2500. A family deductible is double the individual’s to $3000, $4000, or $5000. The only thing covered under the deductible is well visits. A policy holder has to pay all medical bills including prescriptions until the annual deductible is met. Once the deductible is met then the co-pays begin, or the policy holder could have 100% coverage. These High Deductible type of health insurance plans could save 50% on the cost of health insurance.
Health Savings Accounts:
These could be set up with a bank that would allow tax deferred savings similar to an IRA account. The money in this account could be used for medical expenses such as deductible charges, co-pays, dental expenses, eye glasses, even for long term care insurance premiums. The limit to be deposited for 2015 for an individual is $3,350 and for a family is $6,650. If the money is not spent each year it will roll over to the next year.
Health Reimbursement Accounts:
An employer has the option to provide some coverage on medical claims under the deductible. Example, they will have a $5,000 family deductible. The employer may want to cover the first $1,000 on the deductible. They could use an outside third party administer to manage this $1,000 benefit. This takes the employer out of the responsibility of paying claims and managing the allocated amount. This is basically a form of self insuring that could save a company close to 50% on their premiums.
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