Features of Health Plans

Features of Health Plans

Chenoa Pollard

HCR/220

Wednesday 5, 2014

Dedra Evans

There are a quite a few similarities and differences amongst the major types of health plans. Indemnity plans will let a plan member choose any provider but some procedures will still need preauthorization. With indemnity, the insured is protected by the payer from expenses that are listed on the schedule of benefits. They will have to pay a deductible before payment can begin and will still need to pay a percentage of (coinsurance) following payment. Also, while the indemnity plan may not cover preventative care, others do. For instance, the Health Maintenance Organization (HMO) and Point-of-Service (POS) plans provides coverage for preventative care which aids in decreasing health care costs. Primary care physicians (PCPs) are the main source of health care for the insured under these plans. HMOs are more restricted when it comes to who they allow the member to receive care from. Outside of the PCP, the member is confined to a strict service regimen and medical necessity must be found in order for said service to be paid.

It appears that most of the health plan types offer networks of contracted health care providers who assist the plan members. These networks of providers offer services at a discounted copay. Some of these health plans offer out-of-network providers as well but with extra costs to the plan member, such as, POS plans and the Preferred Provider Organization (PPO) plans. While POS also features lower copayments for providers within the network, PPOs boasts needing no prerequisite referral for specialists discounts for the insured and like indemnity, they require a referral to necessitate some procedures. They also only cover preventative care for various services.

The Consumer-Driven Health Plan (CDHP) is more like the PPO. Charging high deductibles, they, in turn, offer a savings account that helps pay for services until the deductible has been met. This...