Features of Health Plans

By: Kate Brewer
Week 1
Date: 06/07/2015
Course#: HCR/220
Instructor: Ashley Spencer

I believe that there is a health care plan out there for everyone. The Health Insurance Association of America said, “ Coverage that provides for the payments of benefits as a result of sickness or injury. Includes insurance for losses from accident, medical expense, disability, or accidental death and dismemberment.” (http://en.m.wikipedia.org/wiki/health_insurance). The major health care plans are as followed: Indemnity Plan, Health Care Maintenance Organization Plan (HMO), Point of Sale (POS), Preferred Provider Organization (PPO), and Consumer Driven Health Plan (CDHP). Each one of this health care plans their similarities and differences. The Indemnity Plan is also called fee-for-service. This plan was created before HMO’s and PPO’s existed. Indemnity Plan offers protection and security against loss or damage. Another feature of this plan is the patient which provider they would like to be seen by. The patient may choose the provider because an insurance claim is submitted by the attending physician to whomever is paying for the health care expenses. Indemnity Plans allows you to choose any provider, referrals are required if you need to see a specialist, and preauthorization is also required. They also have high deductibles, low co-payments, limited providers / coverage, and there is limited preventative care. Health Care Maintenance Organization Plan (HMO) is one of the most popular insurance plans. If you belong to an HMO, you can only attain the medical services of the providers that have chosen to be a part of their network. If a person seeks health care outside of the HMO’s network, it would not be covered. If a patient needs to see a specialist they must first go to their primary care physician and obtain a referral. Preauthorization is required in this health in insurance. This just means the provider wants to make the procedure or treatment is necessary for the health and well being of the insured patient. Just like the Indemnity Plan, Health Care Maintenance Organization offer low co-payments, Limited amount of providers within their network, but they do cover preventative care. Another popular medical insurance plan is a Point of Sale (POS). In a POS a person can choose providers that are within their