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3. Private health insurance - Comparison of plans and providers In the United States, private health insurance plans can be written as group or individual

3. Private health insurance - Comparison of plans and providers In the United States, private health insurance plans can be written as group or individual plans, or as indemnity or managed care plans. Comparing Private Insurance Plans Clare purchases health insurance coverage for herself. This is an example ofan individual insurance plan. Indemnity, or fee-for-service, plans and managed care plans cover medical expenses if you are sick or injured, but in different ways. The following questions examine the general differences between the two plans. Taking a closer look at how these plans provide coverage will help you begin to customize a health care plan that best suits your requirements. Select the plan that most closely matches each given description. Indemnity plan Managed care plan Insureds create contract with an insurer who does not provide health care services

The higher the deductible, the lower the premium

Insured receive health care services from a designated group of providers

May not even involve an insurance company

No annual deduction is incurred, but a small co-payment may be required

Now that youve taken a closer look at the differences between these types of plans, consider the following statements. Each indicates common preferences and situations. Select the type of plan to which each statement most closely aligns. Indemnity plan Managed care plan I prefer the flexibility of increasing or decreasing the size of my deductible to influence the cost of my health care insurance.

I believe prevention is the best medicine.

Id prefer to pay a small copay rather than a larger deductible.

There are several types of managed care plans, including group health maintenance organizations (group HMOs), individual practice associations HMO (IPA HMOs) preferred provider organizations (PPOs), exclusive provider organizations (EPOs), and point-of-service (POS) plans. Deciding which particular type of practice would best meet your needs requires knowing the major characteristics of each. Identify the particular form of private health care organization or plan described by the following three clues. Clue #1: Under this health care plan, doctors provide medical services in their own offices or in an affiliated local community hospital. Clue #2: I will pay a $5 to $30 copayment each time I want to receive medical services or a prescription under my plan. Clue #3: Many of these plans no longer require me to select a primary care doctor. If I want my plan to exhibit these characteristics, then I should purchase

an IPA HMO a PPO a Blue Cross/Blue Shield plan a group HMO

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