HEALTH INSURANCE - HMO OR PPO
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When you fill out the request for quote, I will be able to give you a quote on either a HMO or a PPO or both.
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You may want to take a look at Health Insurance Frequently Asked Questions if you are not familiar with what an HMO or PPO is and what the differences are in the two concepts.
HMO or PPO,That is the question
Some people who have had HMOs are looking for alternatives to their HMO because of perceived inflexibility or because of premium increases. The one thing they don't want to give up is their CO-PAYS for doctor visits and prescriptions. If you are one of those people, then you will want to look at the plans described below..
Many people are looking for a combination plan. A PPO plan with "HMO like" copays. A PPO plan with copays that give you benefits like:
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Dr. visit copay that cover all treatments billed through the doctor's office
- Annual Wellness benefit for a Co-pay
- Copay type Prescription card for 30 days supply at a pharmacy or
90 day supply through mail order.
- Coverage for the first $500 of expense for an accidental injury without a deductible at any Hospital or doctor's office.
The above benefits would NOT be subject to a deductible or any coinsurance. Everything else would be subject to the deductible chosen and the coinsurance (Note: Golden Rule's Copay Plans have a $50 to $100 deductible for the Rx Card and the Wellness benefit is available the second year, but it is generally less expensive than the Celtic Plan). This allows the company to lower premiums plus give the HMO client the coverage they don't want to give up. It also allows people to feel more comfortable with raising their deductible, which also lowers the premium, because most of their day to day needs are met without the deductible
Other Features
1. No "Gatekeeper" doctor (PCP) - Many HMO's make you choose and stay with a Primary Care Provider.
2. Out of Network doctors and Hospitals are covered (You will get a higher reimbursement for a PPO provider).
3. Nationwide or Regional network of Preferred Providers not just a list of local doctors.
4. No Balance Billing if a Preferred Provider is used (referred to as the amount above "Reasonable and Usual").
5. Preferred Provider discounts even if you have not yet satisfied you deductible
6. Mail order Pharmacy allows 90 day supply for one low copay.
Other Major Medical Plans & HMO Plans
Basic "Catastrophic Coverage" Plan Covers Hospital & Outpatient Surgery Only.
The most affordable health insurance available to those who prefer basic coverage.
It is the perfect coverage for individuals who:
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Believe cost is the bottom line
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Need affordable health coverage for only the more costly health care needs
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prefer the basics in covered expenses
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Make sure the plan cover Outpatient Surgery. (Many procedures that were done in a hospital are now down on an outpatient basis.)
With a Basic Plan, less money is spent on options that you don't want.
Important Note:
Premiums for a Basic Plan are significantly less because coverage is not provided for many outpatient services (i.e. Doctor office visits, diagnostic testing, and prescriptions.