Health Plans

Health plan is the tended term used by managed care organization or systems providing health care coverages such as Health Maintenance organization, Preferred Provider Organization, and Point of Service Plan. This type of health plans are also referred to as a subscription-based medical care arrangement similar to prepaid dental, prepaid legal and prepaid vision plans to name a few. Managed care is the term used in the United States for organizations which provides reduced cost of health benefits and care and improved quality care using variety of techniques and mechanism. Sample techniques include increased beneficiary cost sharing and selective contracting with health care providers.

Mainly there are eight known manage care organization/system providing health plans: Health Maintenance Organization, Preferred Provider Organization Health Plans, Exclusive Provider Organization, Point of Service plans, Indemnity plans, Network Health Plan, High Risk Insurance Pools, and Catastrophic Health Plans.

Two of the popular manage care and how they work is listed and stated below:

Health Maintenance Organization Health Plans - HMO, if we compare to other manage care organization, their plans offers a wide range of health care services. After becoming a member, they will require the insurer to have his/her own primary care physician which will they care most of the healthcare needs otherwise a specialist is needed. If so, a referral from the assigned physician is still needed. As we have said, there are wide ranges and there are many variations to choose from. This plan maybe one of the offering lower premiums as before a coverage starts, the insurer may not be required to pay deductibles and co-payments will probably be minimal. The plan is also hassle free since it doesn’t generally need to submit insurance claims to the insurance company.

Preferred Provider Organization Health Plans – for an individual and the family market, this plan is by far the most popular type of plan. Unlike HMO, PPO allows insurer to visit any network physician or health care provider they wish without a referral from their PCP or primary care physician. However, members of the plan are encouraged to use their networks preferred doctors; hence, a PCP won’t be needed anymore. But keep in mind, that whoever healthcare provider are chosen, out-of-network services covers lower benefit level than in-network services. Again, unlike HMO, before the coverage of the insurance company starts, an annual deductible pay is most probably collected to the insurer. Co-payment is most likely to be required of about $10 – $30 for covering certain percentage of the medical bills.