Features of Health Plans
There are many similarities and differences among the major types of health plans. The indemnity plan usually receives a bill from the physician. This bill will be paid provided the insured is current with their premiums, has paid their deductible, and their 20% of the total bill. Health Maintenance Organization’s require that the primary care physician manages care and makes referral’s for some services sometimes the HMO calls for a second opinion. Physician’s can benefit from the capitation in HMOs, only if patients do not make appointments. However, physicians can find that they are giving away services if too many patients need healthcare during the specific time period. HMOs have a low copayment and do cover preventive care; they do not pay for out-of network nonemergency services. Point-of-Service (POS) plans are used by people who do not like the restrictions of an HMO. The insured have more options but have more out-of-pocket fees. POS plans also cover preventive care. Preferred Provider Organization (PPO) allows visits out of their network of physicians, but discounts visits within the network. There is preauthorization required for some procedures, but referrals are not required for specialists. PPOs cover preventive care and the cost of out-of network physicians is covered but more expensive than a physician within the network. I think that PPOs are more consumer friendly because they do offer discounts for physician’s in the network and they cover preventive care visits. This was the first time I have ever heard of consumer-driven health plan. This plan may be a little more consumer friendly because the insured pays lower premiums but higher deductibles.
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