health Insurance

Seems like everyday the cost of medical care is increasing. Health insurance is essential if you expect to meet your medical needs at a reasonable expense. While increasing premiums may be the only constant in the quite complex and always changing world of health insurance, the more you know about some of the basics, the better off you'll be.

Health insurance plans are never one-size-fits-all, and what may be the best plan for you may not work at all for someone else. The plan that suits you best will depend on a variety of factors like what kind of health care you require, whether you have family that needs to be covered and their health care needs, as well as a few personal factors. Depending your own personal circumstances, some companies will provide you with better rates than others. But you don't need to be a certified expert, or even hire own, to find the best plan for your needs. LifeSafeguards is here to connect you with your best coverage, but the more you understand the different types of plans, the better.

HMOs

Like a club for both patients and doctors, Health Maintenance Organizations (HMOs) are set up by insurance companies to provide medical services from participating physicians, clinics and hospitals to the HMO's subscribers. By setting up the plan, selecting a group of doctors to participate, and getting everyone to agree on certain fees and costs, the insurance company is able to control expenses and pass on lower prices to you. There are some drawbacks, however. If you join an HMO and your current doctor is not in the network, you will not be able to bring him or her with you. It works like this:

• After you select your primary care physician (PCP) from your HMO's list of participating doctors, you will see your PCP for all regular medical care like annual check-ups and health issues. If something should happen where you require a specialist, hospitalization, or lab work, your PCP will refer you to a provider or facility. Your primary care physician must authorize any service required for it to be covered by your HMO.
• You may have to pay a small fee (co-payment) to help cover some of the cost for each doctor or hospital visit. Usually the co-payment is around $15 regardless of the cost of the services provided.
• Depending on your HMO, you may have to pay extra for certain services like emergency room visits, mental health services or addiction rehabilitation services, for example.
• There are no claim forms to fill out which makes HMOs relatively simple systems.

PPOs

Preferred provider organizations, PPOs, offer more selection and freedom for their members, but this flexibility often carries higher costs. Like an HMO, a PPO is a type of network of physicians and clinics, but rather than selecting one primary doctor a subscriber may see any doctor in the network at any time. Subscribers do not need referrals to see specialists. One may even see doctors outside the plan but often for a significantly higher fee. PPOs work like this:

• When you enroll in a PPO, there are several decisions to make regarding the insurance options within your plan. These choices will apply to you and any dependants you enroll in the plan with you. Usually these options can only be changed once per year during the "open enrollment period."
• You will be proved with a list of participating medical professionals which you can use to find the best care for you. Of course, with the PPO, you also have the luxury of continuing to see your current doctor.
• You may still be required to pay the co-payment for any services provided. The co-payment covers a portion of the costs for office or hospital visits and it often required regardless of what the visit costs.
• Some services may still cost extra depending on how thorough your plan is. Some areas not covered by all plans include: emergency room visits, mental health care, or chemical dependency support services.

Point-Of-Service

A point-of-service plan combines some of the characteristics of the PPO and the HMO. After selecting a primary care physician, he or she will control all aspects of your care. All services you receive under your doctor's supervision (including referrals) are covered in full. Typically, any care received by an out-of-plan provider will be reimbursed, but there's often a much higher co-payment or deductible. Essentially, a point-of-service plan allows you to decide how to best use your plan in each situation, as a PPO or an HMO.

Traditional Indemnity/Major Medical

This plan offers it's subscribers the greatest deal of freedom out of the most common types of plans. Under rational indemnity, you are able to see any health care professional you choose for any service your plan covers. When you enroll in the plan, you will be able to choose your own deductible along with several other options for the plan. Traditional indemnity/major medical coverage works like this:

• When you choose your deductible, it applies to each individual in your plan. So if you set a $300 deductible for your plan that covers yourself and your spouse, each of you will have to pay out $300 in medical expenses before the plan starts to kick in. Generally, there is a maximum of three deductible allowed per plan.
• Any expenses over and above your deductible are generally split between yourself and the insurance provider. This setup, where the costs are split, is called coinsurance. If you and your provider set up, for example, a plan with an 80/20 provision, the insurance provider will cover 80% of the expenses and you will be liable for covering the other 20%.
• Coinsurance maximums are set in place so that after you meet your deductible, you won't liable for rapidly escalating bills.
• Some services may still cost extra depending on how thorough your plan is. Some areas not covered by all plans include: emergency room visits, mental health care, or chemical dependency support services.