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Types of Health Insurance:


1. Indemnity Plan: An indemnity plans is one of the oldest plans for health insurance. They are extremely costly and there are not many still in existence. It is the least restrictive of all health plans out there. A contract is between the individual and the insurance company whereas traditionally the patient would incur a claim at the doctor’s office Jackie Robinson Youth Jersey , pay the doctor, get a copy of the bill and then submit it to the insurance company. Thus the doctor could charge whatever he wants for the service and in some cases, the insurance company would have to reimburse the patient accordingly. There are no networks or referrals needed. All checks go to the patient.


2. Health Maintenance Organization (HMO): An HMO is the most restrictive type of health coverage. An HMO is a contract between the doctor and the health carrier. In almost all instances there is a network involved, the patient must get referrals, there is a primary doctor (gate-keeper) Mike Piazza Youth Jersey , and the doctor is paid per head (capitated) whether or not he sees the patient. Benefits are paid only in network providers and no benefits would be paid if the patient goes out of the network. Advantages to the doctor, he gets a set amount of income every month, has an immediate patient client base, and the advantage to the patient is typically lower premiums and smaller copays. Other characteristics are the doctor gets a bonus or percentage of patients not referred to specialists. All checks go to the doctor. Other than deductibles, copays Clayton Kershaw Youth Jersey , and non-covered services, a collection agency may not collect from the individual patient.


3. Preferred Provider Organization (PPO): A PPO is a plan that allows patients the benefits of a network that does not require referrals and if the patient uses the in-network doctors, he typically has a modest copay and deductible and coverages are richer than if he goes out of network. If the patient goes in-network, typically he does not need a referral thus there is no gate-keeper. If the patient decides to go out of network, he still will have coverage Justin Turner Youth Jersey , however the copays and deductibles are higher and the coverages are more restrictive and limited. In both cases, in and out of network, the doctor is paid fee for service, thus he has an incentive to see the patient and in-network payments from the health insurance carrier is paid directly to the doctor. This plan is less expensive than the indemnity plan but more expensive than the HMO. The advantage of a network for the doctor is the doctor gets the check mailed directly to him and patients are more likely to use a doctor in their network. The advantage to the health insurance carrier is they have a pre-determined negotiated in-network fee that is typically much less than a out of network, non-negotiated fee.


4. Point of Service (POS): A POS is a hybrid plan that in-network acts like an HMO (capitated) Yasiel Puig Womens Jersey , requires referrals in-network, has gate-keepers, etc. but allows the flexibility for the patient to go out of network. Out of network claims have higher deductibles and copays and limited and more restrictive coverage of services. In network, the check goes directly to the doctor; out of network, checks go to the patient. Since it has an out of network component Cody Bellinger Womens Jersey , it is not considered an HMO thus is classified as an insurance plan in or out of network and you can pursue the patient (in or out of network). This plan is less costly than a PPO but typically more expensive than an HMO.


5. Self-Funded Health Plans: You may not come across too many of these. These are typically union plans or large single employer plans. They typically fund their own losses up to $200,000 and have re-insurance or stop loss above that amount. They write their own plan documents and are governed by the Department of Labor under the TaftHartley Act and pre-empt state jurisdiction in most cases.


David Weinstein of Cherry Hill, NJ is an accomplished business man who is in the process of writingpublishing a book devoted to the clarification of new rules and regulations as well as compliance for the healthcare professions as well as the general public.


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