What Is a Health Plan?
There are many options when it comes to choosing a plan for your health insurance. You have the option of choosing between an Indemnity or Managed care plan. You can also choose to be part a provider network. You will need to know the differences between an Indemnity and a Managed care plan before you make a decision.
Provider network
A health plan’s provider network is a group of medical practitioners and other healthcare facilities that have contracts with the insurance company. Generally, you’ll pay less if you go to a provider in the plan’s network rather than one outside of it. Each health plan covers a different type of medical services and has a different provider network.
The network is a way for health insurance companies to ensure quality standards are met for their members. For example, a UnitedHealthcare doctor must go through a credentialing process to ensure they are qualified to participate in the network. The goal of this process is to ensure that patients are receiving quality care from highly qualified clinicians.
Copay
A health plan’s copays are the fees you pay when you use certain healthcare services. These fees can vary from one plan to the next. You should review the summary of benefits to find out what you will be required to pay. Most cases will have a separate copay for services received at a primary or specialty doctor’s office, an urgent care center, or an emergency room.
A copay refers to a predetermined dollar amount which you will need pay at the doctor’s offices. If you have a $100 doctor visit, for example, you will pay $20 and your insurance company will cover the remainder. The copay, also known as coinsurance, can amount to up to 30% of the hospital visit cost.
Indemnity plan
An HMO (or PPO) is a type of health insurance plan that offers a wide range of doctors to choose from. Indemnity plans, on the other hand, let you choose any doctor – in network or out – without worrying about your premium costs. HMOs cover office visits; indemnity plans cover costs not covered by insurance.
Although indemnity insurance plans may be marketed as an additional coverage, they are not meant to replace traditional health insurance. These plans are usually paid out in the event of an emergency but may not cover all costs associated with your healthcare.
Managed care plan
A managed care plan is an insurance plan that pays health providers in exchange for a set amount. These plans must pay within a certain range. This is determined using actuarial calculations. Many states use an administrative process to set rates, while others use competitive bidding or negotiation. Hybrid approaches combine both methods.
Managed care plans will help you control the cost and quality healthcare by allowing you to contract with a wide range of medical providers. These plans focus on prevention, early detection and high quality care. In addition, they will provide tiered co-pays for prescription drugs, which will help you save money. Many managed care plans encourage generic drug use over brand-name drugs.