According to the latest United States Census Bureau figures, approximately 85% of Americans have health insurance. Approximately 60% obtain health insurance through their place of employment or as individuals, and various government agencies provide health insurance to 25% of Americans.
Health Insurance can be defined as an official agreement between policy-holder and the insurance company, where in the insurer is committed to pay all the medical bills of the insured person if he becomes ill due to the covered causes or meets an accident.
You can get yourself insured from a private organization or from some government agency. For example, the major proportion of the population in United States rely on private health insurance companies, while the dominance of government agencies in this sector can easily be seen in the rest of the world.
Further, the health insurance policy generally pays for limited medical benefits of the total number listed in the agreement in terms of tests, drugs and the treatments. These limited coverage are known as "covered services". There is yet another list that the medical insurance companies issue, known as "uncovered services", which details the kind of services 'not' covered by the policy. For all such medical treatments, you will have to pay from your own pocket.
Well, an insurer generally has several options available to him differing in their 'covered services', and hence it is advisable to choose your plan carefully. Here, I will describe a few standard plans, available to an insurer.
1. Indemnity or fee-for service Plans:
The plan provides medical coverage of an insurer by paying a percentage of the medical bills, generally the 80% of the "usual and customary cost". The insurer endures the remaining 20%, also known as "coinsurance".
It would be worthwhile to mention here that the plan usually has some minimum deductible to be paid every year, which having been paid allows the insurer to provide the benefits of the plan.
2. Managed health care
Here in, the insurance company forms cooperatives with certain doctors, hospitals and medical centers, which then provide a range of services to the insurer at a reduced cost. In other words, you will have to pay less for your medical services thereby making your treatments cheaper.
A managed health care plan can broadly be classified in to three sub categories:
· Preferred Provider Organizations (PPOs)
The plan is somewhat similar to indemnity plan, where in the insurer bears a part of fees (much lower than indemnity plan) while the insurance company pays the rest.
· Health Maintenance Organizations (HMOs)
The plan offers you a range of health benefits, including preventive care, for a pre-decided monthly fee, if you get your treatment done from the pre-issued list of doctors and medical centers. However, if you decide to move out of the HMO circle, you shall have to bear the entire treatment cost on your own.
· Point-of-Service (POS) plans
PMO can be considered as yet another form of HMO, with an indemnity plan option. The plan extends to give you the coverage even outside the HMO circle, if you get the outside doctor referred by the ones covered in the plan. Alternatively, you can also refer yourself outside the plan and get some coverage.
