When considering which health plan to choose for yourself or your family, it helps to understand your options. Make sure you understand your four main costs: the deductible, your co-pays, your premium contribution, and your maximum out-of-pocket costs.
What is a deductible?
A deductible is the amount you have to spend before your health plan begins paying for care. For example, if your deductible is $1,500, your health plan will not pay any bills until you have paid $1,500 for covered services during the period of your policy (typically, one year).
What is a co-pay?
The amount you pay as an insured individual every time you receive healthcare.
What is a premium contribution?
The amount you pay for a health plan. This expense is often shared with your employer if they offer a health plan as a benefit to employees.
What are out-of-pocket costs?
Out-of-pocket costs represent the amount you have to pay for medical bills during the policy period before your insurance starts to cover 100% of a maximum specified amount. Many plans do not count co-payments, deductibles, or other expenses toward this amount, so it is important to read the plan details carefully.
Types of Plans:
PPO - Preferred Provider Organization. This type of plan covers care from a network of a wide variety of doctors and hospitals. If you decide to select a provider outside of this network, you may do so, but for a higher cost. You are also not required to have a Primary Care Physician, and consequently do not need a referral from one in order to see a specialist.
HMO - Health Maintenance Organization. This kind of plan requires you to receive care from only providers within its network. You are typically not reimbursed for out-of-network care. You are also required to have a Primary Care Physician and you must receive a referral from that specific doctor in order to see a specialist.
EPO - Exclusive Provider Organization. An EPO requires you to receive care from only providers in its network. You are not reimbursed for out-of-network care. You are also not required to have a Primary Care Physician or receive a referral from one in order to see a specialist.
POS - Point of Service. This plan is an HMO/PPO hybrid. You are required to have a Primary Care Physician within its network, but you are allowed to refer yourself and receive services out-of-network for higher out of pocket costs.
For more information on selecting the best healthcare plan for you, contact your employee benefits office, your insurance company or a local insurance agent.