Health Insurance can be obtained on a group basis through your employer or on an individual basis for yourself and/or your family.
A variety of plans are available including: Traditional Indemnity, Preferred Provider Organization (PPO), Health Maintenance Organization (HMO), Point of Service (POS), High Deductible Medical Savings Account (MSA), Hospital/Surgical plans, Consumer-Directed Health (CDH) plans, and State Children’s Health Insurance Programs (SCHIP).
Traditional Indemnity plans (for individuals or group) provide coverage for a wide range of health care services. You have the freedom to choose your own physicians and hospitals with no reduction in benefits. This freedom, however, comes with a price. These plans are usually more expensive than the other managed care plans listed below.
Preferred Provider Organization (PPO) plans (for individuals or group) offer the potential for lower monthly health benefit costs through a network of physicians and hospitals. You still have the freedom to choose any health care provider. However, you receive greater benefits and lower costs within the network.
Health Maintenance Organization (HMO) plans are usually employer-sponsored group plans that offer easy-to-use health benefits that emphasize preventive care while managing costs. You select a Primary Care Physician (PCP) from the list of network physicians at the time of enrollment. The PCP then serves as coordinator of your health care, including hospitalization and specialty care. Generally benefits are available only in-network.
Point of Service (POS) plans are usually employer-sponsored group plans that offer choice by combining the advantages of an HMO with the flexibility of Traditional Indemnity coverage. You select a Primary Care Physician (PCP) who at the time of enrollment will coordinate most in-network levels of care. You may choose at the time of service whether you prefer to use network providers or non-network providers.
High Deductible MSA plans have two components—a Medical Savings Account (MSA) and a High Deductible Health Insurance Plan.
A Medical Savings Account (MSA) is a tax-favored account set up to pay for medical care and to allow for the buildup of savings to pay for future medical expenses. In combination with a qualifying High Deductible Health Insurance Plan, the MSA gives you a way to fund your health expenses now and save for retirement, long-term care expenses, or to bridge the gap caused by the uncertain future of Medicare.
A qualifying High Deductible Health Plan has three basic features:
With the High Deductible Plan, you can use the tax-favored money you have deposited in your MSA for routine medical expenses.
Hospital/Surgical plans are the low-cost alternative—a way to minimize your premium costs but still have essential benefits in case of hospitalization or surgery.
Consumer-Directed Health (CDH) plans—also known as Consumer Driven Health plans—are employer-sponsored health plans that give employees more control over when, where and how they spend their health care dollars. These plans appeal to consumers who are actively engaged in seeking health-related information—such as comprehensive information on medical conditions and procedures, and access to physician and hospital price and quality information—to give them greater control over their health care spending.
State Children’s Health Insurance Programs (SCHIP) were started in 1997 when Congress created Title XXI of the Social Security Act to provide health care for the growing number of uninsured children in the United States. This legislation provided States with the opportunity to create programs to increase access to affordable health insurance for children.
