Posts Tagged ‘Referral’

Health Insurance 101 Explained

February 2nd, 2010



We all understand the importance of health insurance; however, as the types of health insurance continue to increase it is becoming more and more difficult to select the type of coverage that is best for you and your family. To help you find out which type of policy might benefit you the most, let’s take a look at the most common types of policies.

There is usually a lot of hype regarding HMOs so let’s look at that one first. A HMO is a health maintenance organization plan that works with a specified group of doctors and hospitals within the network. A primary healthcare physician is selected and you must obtain referrals for care that cannot be provided by that physician. The benefits of this type of plan are lower office visit costs and prescription drug co-pays. In addition, there will typically be either no or limited deductible costs for hospital stays. Depending on your coverage, there may also be no pre-existing condition cause limitations. It is also important to understand that your choice of doctors and hospitals will be limited with a HMO and you won’t be able to have out of network services covered.

A PPO or Preferred Provider Organization works similar to a HMO; however, the major difference is that you are not required to select a primary care physician. In addition to the benefit of being free to choose your own physician without worrying about a referral you also gain the benefit of limited or no deductible costs for hospital stays as well as a possible larger selection of physicians that might be available with a HMO. Out of network services may also be covered; however, for a higher charge than in network services.

A POS, or Point of Service, is also similar to a HMO in that you select a primary care physician. The difference is that you are free to choose out of network treatment if you’re willing to pay a higher out of pocket cost.
Another option is what is known as a traditional coverage policy. This type of policy will have a higher monthly premium as well as deductibles. In addition, you will generally be required to pay for services out of your own pocket up front and then submit claim reimbursement forms.

You may also wish to consider various types of disability plans, which cover a percentage of your income in the event that you experience an illness or accident that prevents you from working for a period of time. A short term disability plan will provide benefits from the first day of an accident or the eighth day of an illness up to 26 weeks. Generally, this type of plan will cover 66% of your weekly income.

Long term disability will begin after short term coverage has expired and will provide coverage for a variable term, depending on the policy you select. Some policies are limited to providing coverage up to two years while others will cover you up to the age of 65.

By: Joseph Kenny

Low Cost Health Insurance In Texas

November 29th, 2009



Texas health insurance options are pretty good if you need to get individual or family health insurance because you are self-employed or it’s not available any other way. There are different types of plans, and costs and coverages can vary quite a bit. Here’s how you can find health insurance coverage.

Like in most states, you can get health insurance in Texas that basically falls into two categories: Fee-for-service and managed care.

Fee-for-service: With this type of health insurance policy, you can see any doctor or provider you want and typically go to a specialist without a referral. The provider may bill the insurance company, or you will need to submit a claim form to the health insurance company to reimburse you for the expenses that they cover. The insurance company may cover from 80 to 100 percent of the expenses. You will pay a premium, a deductible, probably a coinsurance amount and will have a maximum yearly limit to your coverage. Texas law requires health insurance companies to pay claims promptly.

Managed care: A managed care plan uses doctors, hospitals, and other providers that are associated in a network. You would become a member of an HMO, PPO or POS network and usually have to use the providers in the group to receive benefits. This put some limitations on who you can visit for health care, but these plans usually provide an affordable health insurance alternative to fee-for-service. Also, Texas law is very comprehensive about protecting your rights when you join a network.

You should get several quotes when shopping for health insurance — at least three. In Texas, one of the easiest ways to get multiple quotes is to go online to an insurance comparison site. These sites allow you to enter your information into a “quote box” or form, and then they’ll provide you with multiple quotes from different companies or agents. Since coverages and plans all differ, make sure to see if the plan you like is giving you the service and coverages that you and your family needs.

By: Scott Lunt