Insurance Plans

Types of the Health Care Plans and their Characteristics

There are five major types of healthcare plans with varied characteristics. First, the Health Maintenance Organization (HMO) is a package covering health services via physicians and healthcare facilities. HMO is characterized by offering the least freedom to select health caregivers as well as dealing with the least amount of paperwork. Second, the Preferred Provider Organization (PPO) is an insurance plan covering health needs for someone together with his or her family members. To illustrate, PPO providing the client with the power of visiting the specialists irrespective of having a referral. Third, Exclusive Provider Organization (EPO) is an insurance plan that allows the subscribers to access all healthcare providers including the specialists in EPO network. Still, EPO plan does not offer coverage outside its network except during the emergencies. Fourth, Point of Service (POS) refers to the hybrid of PPOs and HMOs and it is characterized by covering primary care concerning check-ups as well as accepting referrals. Fifth, the High Deductible Health Plan (HDHP) can operate in all networks whereas others are limited to HMO and EPO plans. Still, HDHP contains high deductible that needs to be fulfilled before a health coverage plan takes effect. 

Importance of Understanding Differences Existing in Insurance Plans

People should have a complete understanding of different insurance plans. To be specific, the aspect of familiarizing with different types of coverage help in depleting confusion emanating from the failure of knowing the things confined in a certain package. Furthermore, the knowledge regarding different insurance aids someone to choose a favorable plan based on subscription fees. Still, the knowledge about various types of insurance plans facilitates the process of determining the strategies followed by different clients while claiming reimbursement or compensation. 

The Similarities between Insurance Plans

The insurance plans normally have similar properties irrespective of the aspect that they are meant to serve a specific purpose. For instance, all the insurances aid their policyholders to manage risk in an effective manner by offering insurance products as well as reimbursing claims confined in the company’s policies. Moreover, these insurance plans help the subscribers to recover after the losses highlighted in the organizational policies. In addition, all the insurance companies reimburse its client upon the request of a given service or product within the dictated network.

Differences between Various Insurance Plans

The insurance plans such as EPO, HMO, POS, PPO, and HDHP differs in various ways. To illustrate, unlike other types of insurance plans, EPO can only cover subscribers who use hospitals, specialists or doctors in the approved network. Moreover, HMO is a unique coverage since it limits compensation to care given by healthcare givers who contract with or work for HMO. Furthermore, POS plan caters for some bill if the clients used the services in its network. On the other hand, PPO is suitable for instance where the health insurer assigns contracts for uncovered clients. In addition, HDHP differs from other plans since it has higher deductibles and lower premiums. 

Impact of Out-of-Date Policy on Facility Reimbursement

The notion of failing to pay the agreed amount within the stated time can contribute to adverse implication on the individuals registered with different insurance companies. For instance, when the clients fail to pay their dues on HMO plan, these individuals cannot receive any form of reimbursement until they clear the arrears. On the same note, the lateness while paying monthly insurance contributions can lead to penalties, which also block the subscribers from getting the intended help. Based on the above information, it is always essential to clear arrears and fines before claiming compensation to avoid inconveniences.

References

Claxton, G., Gabel, J., Gil, I., Pickreign, J., Whitmore, H., Finder, B. … & Hawkins, S. (2006). Health benefits in 2006: Premium increases moderate, enrollment in consumer-directed health plans remains modest. Health Affairs, 25(6), w476-w485.

Ellis, R. P., Bachman, S. S., & Tan, H. R. (2017). Refining our understanding of value-based insurance design and high-cost sharing on children. Pediatrics, 139(Supplement 2), S136-S144.

Wagner, E. R., & Kongstvedt, P. R. (2013). Types of health insurers managed health care organizations and integrated health care delivery systems. Essentials of managed health care. Burlington: Jones & Bartlett Learning, 21-43.