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Group health insurance is the employee benefit most valued
by your employees. Most health plans cover doctor office visits,
hospitalization, emergency room care, prescription drugs and
a number of other medical conditions. Coverage is available
to companies and individuals.
How to Choose a Health Plan that's Right for You?
First, determine what your needs and preferences are. Here
is a list of questions you may want to ask yourself:
Do I want a high, low or no deductible plan?
Do I want a plan with prescription drug service?
Do I want the freedom to choose my own doctors and hospitals?
Do I want to be covered when and where I travel?
Once you have decided what you want in a plan, you may pick
and choose what plan best suits you. There are basically three
kinds of plans:
Indemnity -- The traditional plan also known as fee-for-service.
It allows you to choose your own doctors and hospitals. After
a deductible, the plan usually pays a certain percentage (e.g.
80%) of your claims until a maximum out-of-pocket expense
is reach (e.g. $2,000). It then pays 100% up to the plan's
maximum.
PPO -- Preferred Provider Organizations have negotiated
special rates with doctors and hospitals. This allows them
to pass on the savings to the insured in the form of lower
premiums. The insured may also benefit by virtue of paying
smaller co-insurance amounts if they use in-network doctors
and hospitals. You may still choose your own doctors and hospitals.
Your benefits will, however, be greater if you use "in-network"
doctors and hospitals.
HMO -- Health Maintenance Organizations provide a wide
range of comprehensive health care services using a network
of doctors and hospitals. Care is provided often without a
deductible and a low doctor visit co-pay. Unlike PPO's, however,
they do not allow out-of-network services except in the case
of an emergency. A primary care physician will determine the
necessity to refer the patient to a specialist.
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