Types of Group Health Insurance Policies
As you look through the various types of health insurance policies out there, you will notice that each one has different rules and fees as well as different types of coverage.
Fee for services
With this policy, you will be able to select any doctor or hospital of your choice. There is a monthly premium and there is a yearly deductible that needs to be met. If you are single, the deductible could cost around $250.00 a year. For the family deductible, this could be up to $500.00 a year, and met by at least two people in the family. Once the deductibles are met, the insurance company pays 80% of your bill and you pay the 20 % remaining. Paying your 20% of the bill is called your co-pay. Some services may not be covered.
What this means is that you need to call your insurance company before you go to the doctor or hospital and ask if it is ok to go. If they deny you from visiting the doctor for treatment and you go anyway, you will be required to pay the entire bill. Another way for them to manage your care is they can set a certain amount of doctor visits you are allowed within a one-year period.
Health maintenance organizations
These are more commonly known as HMOs. They have their own doctors, hospitals, labs and surgery centers that they use, as well as contracting with other doctors and hospitals. This type of coverage is prepaid. The co-pay is typically a small $5.00 charge. Hospital fees are $25.00 – 50.00.
Some HMO policies offer a point of service plan. This is when you can refer yourself to a specialist they are not contracted with. If you do this on your own, you will have to pay the co-pay. If you let your doctor do the referral, you might not have to pay at all.