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Q: List and briefly explain the 8 types of medical coverage
A: Indemnity or Fee-for-Service coverage Indemnity health insurance plans allow you go to the doctor of your choice and pay for services at the time of the visit. [ The amount that your health insurance company will pay is a predetermined benefit level of covered medical expenses, based on your deductible and co-insurance amounts. To receive payment for medical expenses, 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 prescription drugs and other medical costs. For this type of coverage, you are responsible for keeping track of all your medical expenses. Although this type of plan is uncommon, it still may be in place in some rural areas where employees live beyond major carriers' managed care networks. Managed care coverage Unlike an indemnity plan, managed care is a health insurance plan like an HMO, PPO, or POS (described below), that encourages insured individuals to use certain providers. A managed care plan requires or creates incentives for an insured person to use providers that are owned, managed, or under contract with the insurer. These incentives may be financial incentives or additional benefits. Managed health care plans differ widely in their details, however, all will seek to steer a patient toward a pre-approved network of doctors and facilities, as well as limit coverage of any treatment sought outside the network. Health maintenance organizations When you join a health maintenance organization (HMO), you pay a fixed monthly fee called a premium. In return, the health insurance company and its physician network provide a variety of medical benefits. From this network, you choose a primary care physician, who is then responsible for your health care as well as for making referrals to specialists and approving further medical treatment. Usually, your choice of doctors and hospitals is limited to those within the network since they have agreements with the HMO to provide your health care. However, exceptions may be made in emergencies or when medically necessary. ]
scijoe21|Points 1575|
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Asked 6/6/2012 6:31:42 PM
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