Managed Care Health Insurance Plan

Over half of the American people, have opted for the Managed Care Health Insurance Plan. There are various types of Managed Care Health Insurance Plans working differently, providing extensive and comprehensive medical services to their customers, and offering financial incentives to those insured patients who opt to use the providers listed in the managed care plan.These include:

• The PPO Plan or the Preferred Provider Orgnisation
• The HMO Plan or the Health Maintenance Organisation
• The POS Plan or the Point of Service Plan

The HMO or the Health Maintenance Organisation

The HMOs are generally termed as prepaid health plans. In exchange for a monthly premium, the HMO provides for comprehensive and extensive care for you and your family members, which is inclusive of doctor's visits, surgery, lab tests, hospital stay, emergency care, X-rays and certain other therapies. The HMO health care insurance policy arranges for this care either directly- that is vide its own group practice, or through doctors and other medical care professionals who are under contract with the Organisation. While usually, the HMO plan member's choice is limited to those doctors or hospitals with whom the Organisation has entered into an agreement with to provide healthcare, exceptions are made in the case of medical emergencies.

What is the Meaning of PPO?

The Preferred Provider Organization is an organized health care Plan that is an agreeable mix between the traditional Fee for Service (FFS) Plan and a HMO Plan. While like a HMO, the PPO member is faced with a limited choice of doctors and hospitals, there is the flexibility to seek the services of a specialist outside of the network, even though the insurer would now be reimbursing only 70% of the cost, and the member would have to be doing all the paperwork for claims himself. Some people find the PPO option preferrable because if their doctor is outside of the PPO network, they do not have to change doctors so that they can join a PPO health insurance policy.

The Features of POS or Point of Service

• The philosophy behind the POS or Point of Service healthcare is simple: lower medical expenses in return for more limited choice.
• The POS Plan member has maximum freedom with regard to managed care.
• His choice is not limited only to HMO network healthcare providers.
• With regard to network care, there are low co-payments, and there is no deductible. For non-network care there is a deductible, however.
• The annual out-of-pocket medical expenses are limited.
• Your actual medical costs will include the monthly premium and the copayment for medical care services covered within the POS network and the Plan.

More than a decade ago, nearly all Americans had an indemnity assurance coverage, wherein they could go to any medical service provider- be it a hospital or a doctor- and the insurance firm and the patient would each pay a portion of the medical bill, as contracted. But nowadays health care has been making rapid strides and has introduced the concept of affordable group health insurance, so that a greater majority of Americans have access to comprehensive yet economically sound group medical insurance cover.

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