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Individual health insurance policies are best suited for individual
whose employer does not offer any or adequate small
group insurance or group insurance
coverage.
If your employer does not
offer group insurance, or if the insurance offered is very limited,
you can buy an individual policy. Typically available are fee-for-service,
HMO, PPO, or POS protection. As individual plans may not offer benefits
as broad as those in group plans, it is wise to consider available options
carefully and fully understand the policy being presented.
Fee-for-Service (Indemnity)
Health Insurance: This is the traditional kind of health care policy.
Insurance companies pay fees for the services provided to the insured.
This type of health insurance offers the freedom to choose doctors and
hospitals. One can choose any doctor they wish and change doctors at
any time. These plans also allow the insured to use any hospital in
any part of the country. Generally a yearly deductible is charged and
a percentage of costs above the deductible are covered. An example might
include a $250.00 deductible and 80% coverage once the deductible is
reached.
HMO (Health Maintenance
Organization) Coverage: These are essentially prepaid health plans.
In exchange for a monthly premium, the HMO provides comprehensive care
for the insured, including doctors' visits, hospital stays, emergency
care, surgery, lab tests, x-rays, and therapy. Care is provided either
directly in its own group practice or through doctors and other health
care professionals under contract. Generally, the choice of doctors
and hospitals is limited to those that have agreements with the HMO.
Although, exceptions can be made in emergencies or when medically necessary.
PPO (Preferred Provider
Organization) Coverage: A cross between traditional fee-for-service
and an HMO. Like an HMO, there are a specific doctors and hospitals
to choose from. In a PPO, though, it is possible to use doctors who
are not part of the plan and still receive some coverage. This type
of plan is well suited for individuals who want an HMO style prepaid
plan, but want to use a doctor that is not part of the network. As with
HMO's, these plans are geared towards preventative care and include
a broad range of services.
POS (Point-of-Service)
Coverage: A Point-of-Service medical plan is basically a combination
of a PPO and an HMO. Like the other types of managed care, POS plans
are established to provide lower cost medical care to those that remain
in the network. Assume for a moment that POS's are structured identically
to PPO medical plans. The major difference between a POS and PPO plan
is that the Point-of-Service plan makes use of a Primary Care Physician.
With the POS plans, if you seek medical care outside of the network,
you will be responsible for full payment. On the other hand, if your
Primary Care Physician gives a referral for you to see a specialist
outside of the network, the insurer will pick up most of the cost. As
with HMO plans, POS plans typically include preventive care and health
improvement programs.
Get an individual health insurance quote.
Read
our Individual Health Insurance Buyer's Guide.
Other insurance policies
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