Be a smart shopper: before you buy, here's what you need to know about health insurance.Shopping for health insurance can be a daunting daunt tr.v. daunt·ed, daunt·ing, daunts To abate the courage of; discourage. See Synonyms at dismay. [Middle English daunten, from Old French danter, from Latin experience. To help you make the right decisions, there are a few things you can do before contacting an insurance broker. The best way to start is to find out what types of health plans are available in your area and to focus on those plans that meet your employee's priorities. Here's a summary of three basic types of health insurance: Indemnity or Fee-for-Service: This plan lets the policy owner choose any doctor or hospital they want. There is usually a deductible amount that must be paid before the insurance company will pay benefits. Once the deductible had been met, the policyholder and insurance company share the cost on a percentage basis. This is commonly referred to as the co-pay and is typically divided so the insurance company pays 80 percent of the cost and the policyholder pays the remaining 20 percent. Indemnity plans usually require that you submit a claim form to be reimbursed for expenses. Usually the higher the deductible, the lower the monthly premium cost. Health Maintenance Organization (HMO HMO health maintenance organization. HMO n. A corporation that is financed by insurance premiums and has member physicians and professional staff who provide curative and preventive medicine within certain financial, ): An HMO provides comprehensive medical care (inclusive of inclusive of prep. Taking into consideration or account; including. doctors visits, hospitalization hospitalization /hos·pi·tal·iza·tion/ (hos?pi-t'l-i-za´shun) 1. the placing of a patient in a hospital for treatment. 2. the term of confinement in a hospital. , emergency care, lab tests, surgery) as well as preventive care Preventive care is a set of measures taken in advance of symptoms to prevent illness or injury. This type of care is best exemplified by routine physical examinations and immunizations. The emphasis is on preventing illnesses before they occur. See also
abbr. 1. phencyclidine 2. primary care physician Pneumocystis carinii pneumonia (PCP) ). Preferred Provider Organization pre·ferred provider organization n. Abbr. PPO A medical insurance plan in which members receive more coverage if they choose health care providers approved by or affiliated with the plan. (PPO PPO abbr. preferred provider organization PPO Managed care Preferred provider organization, see there Infectious disease Pleuropneumonia-like organism, see there ): This type of insurance plan combines elements of the traditional indemnity plan with those of an HMO. Usually, the insurance company has contracts with many doctors for discounted services. Those doctors are thereby considered "preferred providers." If the policyholder goes to one of those providers, they would typically make an office visit co-pay and the physician would file the insurance claim. Most PPOs still provide some level of coverage even if you use a doctor outside the network. Usually, there are more doctors to choose from in a PPO than an HMO. Health-care insurance: 4 questions When considering what type of health plan is right for your company, ask yourself these four key questions: 1. How many times did my employees go to the doctor? 2. How much can my company afford to pay in monthly premiums? 3. How much does my staff want to pay each doctor visit, and how much are they willing to contribute to monthly insurance premiums? 4. How important is prescription drug prescription drug Prescription medication Pharmacology An FDA-approved drug which must, by federal law or regulation, be dispensed only pursuant to a prescription–eg, finished dose form and active ingredients subject to the provisos of the Federal Food, Drug, coverage? Once these questions are answered, the next step is to contact an insurance broker who can provide you with a comparison of the policies and the costs involved. The final plan, or combination of plans, you choose should satisfy how much coverage you need in exchange for the amount of premiums that you can afford. Roy Lamphier is senior director of insurance programs at the Detroit Regional Chamber. |
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