subject: Network Medical Insurance Explained [print this page] In the US, a lot of medical plans come with a network of medical providers. These networks may help the insurers and the plan members keep costs lower. In order to make the most of your network health insurance policy, it is very important to understand how these plans work.
A medical plan network is simply a group, or organization, of health care providers who agree to abide by specific network rules that insurers provide. These rules are intended to keep costs low and claims handling simple. This is an advantage for the health insurance company, who helps pay the bills, and to the consumers who join the plan.
Let me explain three popular kinds of network health insurance policies. These three popular kinds of plans are PPO, POS, and HMO medical plans. They are similar, but there are important differences. If you can understand the differences, it should be easier to select the plan that will be best for you and your family. Of course, the same types of plans may be different from company to company. You still need to read the details of any policy that you are considering.
An HMO plan is the most restrictive. In order to get your health covered by an HMO, you usually have to use on of the plan providers. The insurance company might make an exception once in awhile, but you should assume that you will need to use a network medical provide almost all of the time. They probably make exceptions for health emergencies. They may also be made, rarely, for services not provided by the network. You have to make sure you get any out-of-network, non-emergency services approved in advance to be sure they are covered.
POS (Point of Sale) plans are less restrictive than HMO plans. The insurance functions just like an HMO is you use a network health provider. If you decide to use an out-of-network health provider, your coverage will function like an indemnity health insurance policy. An indemnity health plan simply provides a certain level of coverage, but does not use a network. Assume that you will pay more if you use an out-of-network provider.
Of course, PPO plans are popular these days. They also use a network, and if you use a network provider you get the highest level of benefits. If you use a non-network provider, the plan will cover you, but at a lower level. For example, you may get covered at eighty percent if you visit a provider in your network. The coverage level may drop to sixty percent if you decide to use an out-of-network provider.
Which type of health plan is better for you? The best choice really depends upon your needs, budget, and the plans on the market in your own city or town. If you are selecting a new plan, it pays to shop around. If you already have medcial coverage, it pays to understand how your plan works! That way, you can lower your out of pocket costs and feel more satisfied with your coverage.
by: Marilyn Katz
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