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Oregon Insurance FAQs: Homeowners Insurance
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No single plan will cover
all costs associated with medical care, but some
cover more than others.
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| Types
of Coverage: |
Fee-for-Service
(or Indemnity) Plans
With this traditional plan, you can make an appointment
with almost any medical provider. After your
visit, you or your provider sends your claim to
the Oregon insurance company. If you have met your
deductible for the year, then the Fee-for-Service
plan will pay a percentage of the bill – usually
80%. You pay for the other 20%, known as coinsurance.
Few purchase this traditional type of plan. Why?
Because it's expensive.
Managed Care
This term refers to types of health insurance plans
that provide health care services at a lower cost.
The key to these lower costs? Members of managed
care plans must adhere to certain rules designed
to lower the cost of medical care.
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| Types
of Managed Care: |
Health
Maintenance Organizations (or HMOs)
With an HMO, you receive a range of health benefits
for a set fee. Generally, there are no deductibles
– but most plans require a small copay per
office visit (around $10-25). You must choose a
primary care physician from the plan’s list.
This doctor becomes your “gatekeeper”
for all your medical needs. This is the doctor you
call or see when you are sick, and he or she will
refer you to a specialist or other providers within
the HMO network. With most HMOs you will not receive
benefits if you go out-of-network, except for emergency
care.
Types of HMOs:
- Staff
Model HMO
A form of HMO in which doctors are employees
of the HMO and you see them at a central medical
facility.
- Individual
Practice Associations (IPAs)
Here, an HMO contracts with outside physician
groups or individual doctors who have private
practices. This means the HMO network will include
doctors in various locations rather than only
at a central facility.
More Types of Managed Care:
Preferred Provider Organization (PPO)
This isn't an HMO, but it is another type of managed
care. In this system, you may seek treatment from
an approved network of providers, or may see other
providers outside the network. Usually, you will
pay small copay and satisfy a deductible before
benefits are paid. Then you’ll pay a set coinsurance
amount. It’s less expensive to visit one of
the providers in the plan’s list. You can go
outside the plan’s list, but your share of
the bill will be higher.
Point of Service (POS)
A hybrid of the HMO and PPO is known as a POS plan.
Like a standard HMO, your primary care doctors make
referrals to other providers within the plan. But
if you want to go to a physician outside the network
without consulting your primary care doctor, the
POS plan will pay a predetermined amount of the
bill and your share of the bill will be higher than
it would if you stay in-network. These plans usually
cost more in monthly premiums than straight HMOs,
but they give you the flexibility to call any doctor
– within the plan or not.
Choosing
wisely
If you have a choice from more than one plan,
compare how each plan handles the following:
- Coverages
- Co-payments
- Coinsurance
- Deductibles
- Pre-existing
conditions
- Limitations
on devices, drugs, and access to specialists.
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| Wondering
about some of the terms used in health insurance? |
Here
are some common terms and definitions.
Copay: A fixed dollar amount you pay at the
time services are rendered. Typical copays are for
office visits, prescriptions, or hospitalizations.
Coinsurance: A specified percentage of the
cost of treatment the insured is required to pay
for all covered medical expenses remaining after
the deductible has been met.
Deductible: The portion of your health care
that you pay before insurance starts covering it.
Typically, the higher the deductible, the lower
the premiums.
Pre-existing condition: An illness, disease
or condition an individual has at the time of enrollment
in a health care plan. Pregnancy is not a pre-existing
condition.
Premiums: The monthly or quarterly payments
paid for health insurance.
Catastrophic coverage: This plan pays hospital
and medical expenses above a certain (usually high)
deductible. The maximum lifetime limit may be high
enough to cover the cost of a catastrophic illness.
Long-term care policies: These cover medical
care, nursing care and certain in-home care if you
ever become unable to care for yourself due to an
extended illness or disability.
Disability income insurance: This plan will
provide you with an income if you become unable
to work due to an injury or illness. Benefits are
usually 60% of your income at the time of disability.
Information was taken from Healthinsurance.com
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