Health  Insurance Information 

There are numerous plans, coverages and options you can tailor to your needs. The sections below outline the common Types of Policies and Policy Options. It's a good idea to work with an agent to help you create a benefits package that's right for you and your employees.

Types of Policies
Each plan differs in coverage, payment terms and medical treatment procedures (i.e. available doctors). Below is a list of common policies:

PPO (Preferred Provider Organization): the insurance company has a network of "preferred providers" (hospitals, doctors, clinics, etc.). These providers discount their service fees to your insurance company in exchange for being part of the network. If you use a provider from outside the network, you'll have to submit a claim and likely pay a higher deductible.  This is usually cheaper but not as flexible as the indemnity plan.

HMO (Health Maintenance Organization): all your medical services are provided by the organization of doctors, hospitals, etc. The HMO is much like a strict PPO: you must use the providers they authorize (except for emergencies as defined by your plan). Your doctor refers you to other doctors within the HMO as necessary. The HMO's advantage is that it has no deductibles and usually requires only a small co-payment for each service. There may also be a maximum to what you pay annually "out-of-pocket."

Indemnity (Fee-for-service): allows you to go to any hospital or doctor. You submit a claim and pay the invoice (to be reimbursed later) or authorize the hospital or doctor to collect their fees directly from your insurance company. Although this plan is very flexible in who provides your care, the premiums are higher than other types of health insurance. Also, indemnity plans usually do not provide any coverage until the deductible has been satisfied.

POS (Point-Of-Service): this is an option of HMO with greater flexibility. Your primary doctor may refer you to someone outside of the HMO with minimal or no additional cost. You may also refer yourself to a non-HMO provider, but you'll have to pay co-insurance.

Common Options
After you select the plans and establish the terms, your agent will give you a proposal. The Proposal contains five key areas:

Accident Supplement (AS): In case of an accident, this option would pay for any medical treatment up to the predetermined amount without a deductible. Any costs in excess would then have deductibles and co-payment apply as normal.

Doctor Co-Pay: like HMO's, Indemnity and PPO plans may offer doctor co-payment options. A small fee is paid to the insurance company ($10-$40) for each visit to the doctor. This usually isn't subject to deductibles and co-insurance.

Prescription Card: the card enables your insurance carrier to pay most of your prescription costs. Usually presented at the drugstore, you'll pay only a fraction what it normally costs depending on your policy and type of prescription (i.e. brand name or generic).

Preventive Care: some policies may offer this as either an option or an inclusion. Routine physicals, immunizations, and tests may be covered without a deductible.

Dental: general cleaning and other basic dental care may be included with your policy. Co-payment is usually required for extractions, crowns and other advanced procedures.

Vision: your carrier may include visual benefits, ranging from co-payment eye exams and discounted glasses.

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