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Health Plans Unlimited
8370 S.R. 84
Davie, FL 33324

Phone: 954-693-7977

Fax: 888-793-2784



What kinds of individual and family insurance plans are available?
How does a PPO plan work?
How does an HMO plan work?
How does a POS plan work?
How does an Indemnity plan work?
How does an HSA work?
What is a co-payment?
When can my coverage start?

What kinds of individual and family insurance plans are available? | Back to top

Individual and family health and group insurance plans are usually described as either "indemnity" or "managed-care" plans. The major differences concern which healthcare providers you choose and what co pays or out-of-pocket costs you are going to pay. Typically, indemnity and PPO plans offer a broader selection of healthcare providers than managed care plans. Indemnity and PPO plans pay their share of the costs for covered services only after they receive a bill (which means that you may have to pay up front and then obtain reimbursement from your health insurance company). Unless a co payment for primary doctors is available.

There are several different types of managed-care health insurance plans. These include HMO, PPO, and POS plans. Managed-care plans typically make use of healthcare provider networks. Healthcare providers within a network agree to perform services for managed-care plan patients at pre-negotiated rates and will usually submit the claim to the insurance company for you. In general, you'll have less paperwork and lower out-of-pocket costs with a managed care health insurance plan and a broader choice of healthcare providers with an indemnity plan.

How does a PPO plan work? | Back to top

With a PPO (Preferred Provider Organization) plan, you'll be encouraged to use the insurance company's network of preferred doctors and hospitals. These healthcare providers have been contracted to provide services to the health insurance plan's members at a discounted rate. You won't be required to pick a primary care physician but will be able to see doctors and specialists within the network at your own discretion.

You will either have a co pay with a PPO plan or have an annual deductible to pay with an indemnity plan before the insurance company starts covering your medical bills. You may also have a co-insurance for certain services

With a PPO plan, services rendered by an out-of-network physician are typically covered at a lower percentage than services rendered by a network physician.

How does an HMO plan work? | Back to top

HMO (Health Maintenance Organizations) plans typically enable members to have lower out-of-pocket healthcare expenses but also offer less flexibility in the choice of physicians or hospitals than other health insurance plans. As a member of an HMO, you maybe required to choose a primary care physician (PCP). Today a lot of HMO plans offer open access ( no primary care physician to choose).Your PCP will take care of most of your healthcare needs. Before you can see a specialist, you may need to obtain a referral from your PCP. Today with open access the referral procedure is removed.

With an HMO you'll likely have coverage for a broader range of preventive healthcare services than you would through another type of plan. You may not be required to pay a deductible before coverage starts and your co-payments will likely be minimal. With an HMO plan, you won't have to submit any of your own claims forms to the insurance company. Keep in mind that you'll likely have no coverage whatsoever for services performed by non-network providers or for services rendered without a proper referral from your PCP.

How does a POS plan work? | Back to top

A POS (Point of Service) plan combines some of the features offered by HMO and PPO plans. As with an HMO, members of a POS plan maybe required (unless an open access plan is offered) to choose a primary care physician (PCP) from the plan's network of providers. Services rendered by your PCP are typically not subject to a deductible. Also, like HMOs, POS plans typically offer coverage for preventive care visits.

Typically, however, you will only receive a higher level of coverage for services rendered by your PCP or specialist. Services rendered by a non-network provider may be subject to a deductible and will be covered at a lower level. If services are rendered outside of the network, you'll likely have to pay up-front and submit a claim to the insurance company yourself.

How does an Indemnity plan work? | Back to top

A traditional Indemnity plan offers a great deal of freedom in choosing which doctors and hospitals to use, but will probably involve higher out-of-pocket costs and much higher premiums along with more paperwork.

Under an Indemnity plan, you may see whatever doctors or specialists you like, Though you may choose to get the majority of your basic care from a single doctor, your insurance company will not require you to choose a primary care physician.

However, this kind of freedom will cost you. You'll likely be required to pay an annual deductible before the insurance company begins to pay on your claims. Once your deductible has been met, the insurance company will typically pay your claims at a set percentage of the "usual, customary and reasonable (UCR) rate" for the service. The UCR rate is the amount that healthcare providers in your area typically charge for any given service.

An Indemnity plan may also require that you pay up front for services and then submit a claim to the insurance company for reimbursement.

How does an HSA work? | Back to top

Legislation establishing Health Savings Accounts (or "HSAs") took effect on January 1, 2004. HSAs and HSA-eligible health insurance plans are becoming more and more popular. Here are the basics:

  • An HSA is a tax-favored savings account that may be used in conjunction with an HSA-eligible high deductible health insurance plan to pay for qualifying medical expenses.

  • Choosing an HSA-eligible health insurance plan may help you save money. Typically, the monthly premium on an HSA-eligible high deductible plan is less expensive than the monthly premium for a lower-deductible health insurance plan.

  • Contributions to an HSA may be made pre-tax, up to certain annual limits.

  • Funds in the HSA may be invested at your discretion. Unused funds remain in the account and accrue interest year-to-year, tax-free.

  • Not all high-deductible plans are eligible for use in conjunction with an HSA.

  • What is a co-payment? | Back to top

    A "co-payment" or "co-pay" is a specific charge that your health insurance plan may require that you pay for a specific medical service or supply. For example, your health insurance plan may require a $10 co-payment for a PCP office visit or brand-name prescription drug, after which the insurance company often pays the remainder of the charges.

    When can my coverage start? | Back to top

    You can request that your Individual and Family health insurance plan start anytime between 1 and 90 days in the future. However, the insurance companies will typically need some time to process your application so keep in mind that the actual date for the start of your coverage may vary depending on the underwriting process and the availability of your medical records



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