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Posts Tagged ‘Preferred Provider Organization’

A Traditional Indemnity Health Insurance Plan Or A Managed Care Plan?

Thursday, August 5th, 2010



For many years people felt that they were trapped between a traditional indemnity health insurance plan (a wide range of choice and high degree of security in the event of serious accident or illness which came at a high cost) and a managed care plan (a focus on preventative medicine at relatively low cost but with severely limited choice).

Today however it is possible to some extent to enjoy the benefits of both traditional indemnity insurance and managed health care through a variation on the original Health Maintenance Organization (HMO) model known as a Preferred Provider Organization (PPO).

A PPO is essentially an HMO which means that the insurance company will establish a network of healthcare providers and, in exchange for a relatively low cost, will encourage, or in some cases require, policyholders to seek treatment within the HMO’s network. Where treatment is taken outside of the HMO’s network much, if not all, of the cost of such treatment normally has to be borne by the policyholder. However, in the case of a PPO, the rules for policyholders who wish to seek care outside of the HMO’s network are relaxed.

Within an HMO a policyholder is assigned to a particular doctor or primary care physician (often referred to as a “gatekeeper”) and the policyholder must go through the primary care physician in order to receive treatment. If, for example, the policyholder wishes to see a specialist then he or she will have to be referred by the primary care physician and may or may not have a say in which particular specialist they are referred to.

In a PPO however no primary care physician is assigned and so no referral is required. Policyholders are free therefore should they choose to do so to seek treatment through a specialist who is not a member of the HMO’s network.

There are of course cost implications to this choice and policyholders will almost certainly have to pay more for treatment with a doctor or in a facility that is outside of the HMO’s network than they would if they sought treatment within the network. Nevertheless, unlike the HMO model, the PPO gives the policyholder the choice.

If you like, a PPO provides policyholders with the low cost managed health benefits of the HMO with the option to elect for the greater choice, albeit higher cost, of indemnity insurance when it suits their needs.

It will probably come as no surprise to find that today traditional indemnity policies are fast disappearing and that there are now twice as many people enrolled in PPOs as there are in HMOs.

Health Insurance When Living Abroad

Friday, April 30th, 2010



You may not know this already, but when planning on traveling abroad you cannot take your local insurance with you. You will need to purchase an international insurance plan offered by a multinational insurance company. While they may be hard to track down, it is the best way to assure that in the event of an accident or illness you will be able to acquire medical attention if needed.

Many of these plans will cover you up to six months in another country. When you speak with the insurance company, be prepared to give an extensive list of information to them. This will range from health problems you’ve had in the past ten years, your hereditary conditions to substance abuse, and almost everything else-if it has anything to do with your health be prepared to disclose the information. If you are planning on traveling with more than one family member, then be prepared to give information for each family member as well.

Many times your basic coverage will include emergency treatment regardless of which facility it is administered. This is not the case with minor medical treatment. It is important to know whether you are buying an insurance plan that is an HMO or PPO. If you are under an HMO or health maintenance organization, then you will be limited to receiving care from only the providers who are in their network. You can retrieve a list of all the companies within your insurer’s network upon request. If you are under a PPO, or preferred provider organization, you will have the opportunity to pick the best facility you see fit, but your insurer will only cover a portion of the incurred cost.

If you plan on staying abroad for more than six months then you will need to look into what is called expatriate health insurance. Only larger companies supply this type of insurance, as it is much more extensive with the type of options that can be applied to each policy. The type of treatment options that are covered with expatriate health insurance are those that are labeled as specialty treatments, like chiropractic therapy and acupuncture. There are many options that can be applied to expatriate health insurance depending on your family’s needs and how long you plan on spending abroad.

There are many options for health insurance when you are traveling abroad. While many individuals never consider purchasing insurance when traveling to another country, this should be at the top of your list when planning for a trip. Health insurance should not be taken lightly. Be sure you understand every aspect of your policy before deciding with any one particular company.

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