|
Obtaining Healthcare
Coverage
is not always as easy as one thinks!
For those who
do not have group coverage, selecting the right health plan can often
times become complex and frustrating. This site is dedicated to
those who require some background information so that they can make the
right choice. Often times just understanding the terminology used
by health plan providers can also lead to confusion. This site
will also provide a basic understanding to terminology most used by carriers
and health sales agents.
The following basics should be understood before making any decision
regarding your health plan purchase.
- Providers
- Understanding Plan Types
- Understanding Coverage Types
- Understanding Basic Terminology most used carriers and their agents
- What questions should you ask yourself prior to making a decision
- Are there additional links to assist you in obtaining the information you need
Health Insurance
Providers - a number of sources are available for individuals seeking
health insurance protection.
For the most part, health insurance providers can be divided into three
main categories: commercial, service providers and the state or federal
government. The main objective is to provide protection against any
financial costs that come with illness, injury or disability.
Commercial Insurance Providers:
Health insurance can be written by many providers including, life
insurance companies, casualty insurance companies, and single line
companies that specialize in one or more types of medical expense and
disability income insurance. This includes both individual and group
policies.
The basic concept behind commercial insurance companies is that they
operate on the reimbursement approach. which in plain English means: You
receive treatment, charges are submitted to your provider and then you
are reimbursed for these expenses, with the only difference being that
you have what is called 'the right of assignment' built in so that these
reimbursed payments go directly to the healthcare provider and not to
you.
Service Providers:
With service providers there is a different approach. With this approach
a monthly premium is charged and as a result of this monthly payment you
receive the benefits as services provided by the hospitals and doctors
provided in the plan.
HMO's and PPO's are examples of this type of provider.
State and Federal providers:
Is protection provided by a state or federal government program.
Examples of these are: Medicare, Medicaid, Social Security Disability
and State workers, compensation programs.
Alternative Method Providers:
In addition to the above three types of providers there is what's called
'alternative methods of providing health insurance'. An example of this
is called Self Insurance. For businesses and individuals this an
alternative to commercial or service health insurance plans. These can
be diverse but the many of these plans are administered by insurance
companies that are paid a fee for handling the paperwork and processing
the claims. When an outside organization or insurance carrier is
involved in providing these functions it is called ASO (administrative
services only) or TPA (third party administrator.
It is important to remember, regardless of your needs and budget,
maintaining some form of health coverage is vital. Age, health
conditions, pre-existing conditions, and finances, all contribute to
making a wise choice, but being without any type of coverage can often times become a
financial catastrophe.
|
