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Mega Health Insurance
Health insurance is a necessity. Some people make
the mistake of declining mega health insurance coverage. They
justify it with the notion that they are healthy, never see the
doctor, and don't have any major health issues. Unfortunately, no
one knows what the future holds in terms of health, making mega
health insurance necessary.
Typically, there are three types of mega health insurance in the
United States.
First is the self-insured. It's estimated that roughly 30% of the
population in the US fall into this category. Self-insured
individuals and families are those that fund their mega health
insurance entirely out of their own pockets. They receive no
assistance from an employer for payment of their premiums. They
might, however, qualify for tax breaks. This group also includes
uninsured persons; that is, people with no mega health insurance
coverage whatsoever.
The second type of mega health insurance is the managed care plan. A
managed care plan is a plan that offers the services of a network of
affiliated health providers. Utilizing health providers within the
network allows the participant contracted prices.
Within the managed care plans of mega health insurance, there are
three categories: Health Maintenance Organizations (HMOs), Preferred
Provider Organizations (PPOs), and Point of Service (POS).
HMO members pay a monthly fee. No matter how much or how little
medical care the participant requires, the fee does not fluctuate.
HMOs usually require that members utilize health care providers
within the HMO network. HMO members must select a primary care
physician when electing for mega health insurance.
PPOs offer more flexibility than HMOs. PPOs will allow members to
venture outside the health provider network without requiring
referrals from the primary care physician. PPOs encourage members to
stay within the network by offering small co-pays. If venturing
outside the network, costs must be paid in advance and a percentage
will be reimbursed by the PPO.
POS plans are not as common. These plans are hybrids of the HMO and
PPO. There is a network of providers and members can venture outside
it. If that is the case, payment for services rendered is collected
at the time of service, and the POS reimburses the member.
The third type of mega health insurance is an indemnity plan.
Members of indemnity plans can seek medical services from any health
care provider they wish. There are no strict rules with indemnity
plans. The downside is the cost: these are the most expensive of all
mega health insurance plans.
Which of these are best for your situation? If you're self-employed,
you might not have much choice but to select a self-funded plan. If
you're employed and you can stay with one primary care physician
without needing to venture outside a network of providers, an HMO
might be a good choice. Consult with your Human Resources benefits
representative to evaluate your needs.
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