Late 20th century, health maintenance organizations (HMO) gained popularity in America. The reason was to control medical expenses. American medical institutions charged pre-negotiated fees for prescription medicines and medical services. Preferred provider organization (PPO) or participating provider options are also the best alternatives of HMO that you can use. It provides features of the traditional fee structure for a service insurance plan. With it, patients can select care providers according to their wishes. They can also follow the strategies of HMO at a lower cost.
PPO registered patients can also see any medical care provider anytime. There is no need to have a referral from a primary medical physician. If you use the preferred providers of any insurance company, it bears a high percentage of the cost. Insured pays a specific amount for medical services in the case of HMO and PPOs. That expense includes a co-payment fee that the insured pays at office visits, as it is one of the standard ways of payment.
Let’s learn more about health insurance and its types.
Types of Health Insurance
We can classify into three groups the different types of health insurance that we are currently facing:
- Medical insurance: we are faced with the type of insurance most demanded by users. In medical insurance, the insured chooses the doctors and centers he wants. The insurer will provide you with a list, including doctors and centers, you can attend at no additional cost. This form of insurance can be contracted individually or in groups (for example, families and businesses).
- Expense reimbursement policies: in this type, the insured pays all medical expenses so that the insurance company then reimburses them. The refund is usually 80% to 100% of the total amount.
- Mixed systems: This modality integrates medical insurance and the expense reimbursement policy.
The insured has the option to choose the doctors and the centers (provided they are within the medical insurance of the insurer), initially paying him that is the number of health services. Later the insurer will refund the appropriate amount. - Subsidy insurance: this form of insurance is based on the insured’s subsidy if he obtains a sick leave.
There are other aspects that you must consider regarding health insurance.
In addition to everything discussed above, we must consider the following two points:
- Medical chart of the insurer: the medical chart shows all medical professionals who fall within the policy’s coverage, and therefore the insured can choose. The medical staff is divided into subject indices and doctors and hospital centers indices. The medical specialties are skewed in the first one, and the hospital centers are named with the doctors. In the second, the hospital centers are sorted alphabetically by populations.
- Pre-existing (pre-existing diseases): there are different pathologies that the insurance company may consider. They already existed before formalizing the contract with the insured. Therefore, it will not cover the expenses arising from that disease.
Insurers can increase the premium to be paid, offer coverage or not for those diseases, or even not insure the potential client. It is for those diseases that were already diagnosed before the contracting of the insurance.
When hiring medical insurance, insurers, as a general rule, will request a medical examination to consider the degree of risk they assume when covering that person. Then you can see the questionnaire to fill out for the medical examination. You have to mention the surgical interventions to which the possible insured has been submitted, hospital admissions, pathologies, diseases suffered, etc.
Catastrophic coverage
We need this coverage at the time of emergencies only. With this coverage, you have a facility of three visits to a plan. In it, the doctor participates in preventive care. For catastrophic coverage, you will not need to pay high monthly premiums. But the deductibles become high at the time of need for usage.
You can offset all your health insurance plans through a flexible spending account or saving account. But you will not include high deductible plans. Perhaps, your employer offers the facility of HAS and FSA so, you should learn about it in detail. You can download and check information for the coverage for your health insurance plan.
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