Term group plan means that all the employees must compulsorily accept the coverage despite of physical condition. Usually the employee has to pay the first premium within 30 days of employment or he will be forfeited from the right to automatic coverage. Group health plans include employer sponsored ERISA plans - both insured and self insured and non- ERISA plans such as church plans. Group insurance is generally the least expensive kind.
Some organizations offer only one health insurance plan and others offer a variety of plans like indemnity plan, health maintenance organization (HMO), or a preferred provider organization (PPO). This type of group health insurance is famous in California.
Indemnity health insurance plans gives you the benefit of choosing a licensed doctor of your choice and then pay him for the services at the time of the visit. To receive payment for medical expenses you have to fill a form and send them to insurer. Sometimes your doctor may do this for you. You also have to keep receipts for prescription drugs. If you want this type of insurance you have to keep track of all your medical expenses. This type of plan is mostly found in rural areas. Certain features include your choice of deductibles, coinsurance levels, maximums and benefit levels.
In health maintenance organization (HMO) you have to pay a monthly fee called a premium. But you can't choose a licensed doctor of your choice in this type of health insurance. The health insurance company has a huge number of physician networks who provide a wide variety of medical benefits. From this network, you choose a primary care physician who will take care of your health related problems. The choice of doctors and hospitals are limited those within the network since they have agreements with the HMO to provide your health care. The health care services generally require you to make a co-payment. If the HMO is efficient and keeps its members healthy, it will make a profit. But if there are too many members who need care its profits are smaller or it may lose money.
Preferred provider organizations are made up of physicians, hospitals, or other providers which provide health care services at a reduced fee. PPOs offer more flexibility by allowing members to meet a licensed doctor who are out of network at a greater expense to the policy holder. But if visits are made within the network it requires only a small fee. There is often a deductible for out of network expenses and a higher co-payment.
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2 comments:
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