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Health Insurance Major Medical
There are 4 main types of health insurance major medical policies: PPOs, HMOs Traditional Plans and Fee for service plans. The PPO (Preferred Provider Organization) is the type of health insurance major medical plan where you have a large choice of providers within a network. You can choose any provider in the network and can change providers whenever you like. In a calendar year after you pay your deductible the insurance company will start paying a certain percentage of the covered medical expenses. This is called the co-insurance. |
| Supplemental Medical Insurance offers voluntary employee health insurance benefits including
dental, accident, life, cancer, long-term care, and short-term
disability. |
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For instance they'll pay 80% and you'll pay 20% until you reach the stop-loss amount, after which they will pay 100% of the covered medical expenses. Health insurance major medical plans vary according to the benefits they offer. Some plans offer special options; Doctor's office visit co-pays, Maternity coverage, emergency room coverage, critical illness extra benefits, life insurance. |
The HMO (Health Maintenance Organization) is a type of health insurance major medical plan where you choose one doctor who is your primary care physician. You must first get permission from your primary care doctor if you need to go to a specialist. That is why they are sometimes called Gatekeepers. You do not have freedom of choice. You pay a monthly premium, and most of your services will cost very little. Although they are still available, many HMOs have gone out of business in the last few years. Traditional or Indemnity Plans are not as available as they were 10 or 15 years ago. This is the type of health insurance major medical plan where you choose any doctor or any hospital for your services. You will still have a deductible, a co-insurance amount and a stop-loss, just like with the PPO plans. The difference is that here you have complete freedom of choice.
Fee for service-This is the traditional kind of health insurance major medical policy. Insurance companies pay fees for the services provided to the insured people covered by the policy. This type of health insurance offers the most choices of doctors and hospitals. You can choose any doctor you wish and change doctors any time. You can go to any hospital in any part of the country. With fee-for-service, the insurer only pays for part of your doctor and hospital bills. This is what you pay: A monthly fee, called a premium. A certain amount of money each year, known as the deductible, before the insurance payments begin. To receive payment for fee-for-service claims, you may have to fill out forms and send them to your insurer.
Sometimes your doctor's office will do this for you. You also need to keep receipts for drugs and other medical costs. You are responsible for keeping track of your medical expenses. There are limits as to how much an insurance company will pay for your claim if both you and your spouse file for it under two different group insurance plans. A coordination of benefit clause usually limits benefits under two plans to no more than 100 percent of the claim. Most fee-for-service plans have a "cap," the most you will have to pay for medical bills in any one year. You reach the cap when your out-of-pocket expenses (for your deductible and your coinsurance) total a certain amount. It may be as low as $1,000 or as high as $5,000. Then the insurance company pays the full amount in excess of the cap for the items your policy says it will cover. The cap does not include what you pay for your monthly premium.
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| Supplemental Medical Insurance does not cover eye and hearing exams, foot care, immunizations, or physical exams. |
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