Hi, are the indemnity policies better than the HMO or PPO plans?
Plasticmind
Total Comments: 9
Posted: Thu Nov 20, 2008 07:34 am Post Subject:
See..the HMOs and PPOs won't permit you to pick your preferred hospital or physician. In comparison, the indemnity policies would allow you to do so. They are the fee-for-service plans and hence offer you the option to pick your health care services. It would just cost you for the services through the life of your policy based on your policy specifications. Yupp, they could be a bit costlier at times ( as compared to the HMOs or PPOs) but you have a number of pay-back options.
Posted: Thu Nov 20, 2008 08:46 am Post Subject:
You may need to pay for the deductible. Once you pay for this amount, then you'd be eligible to receive the benefits promised in your sign-up papers. If you have not defaulted on your health care charges...and then come across an event which has been promised to be covered under your policy, you're bound to have it. So, you pay your deductibles and you won't need to worry about the rest. Crossbreed
Posted: Thu Nov 20, 2008 11:54 am Post Subject:
So, you pay your deductibles and you won't need to worry about the rest.
You may need to pay for a co-payment as well. This is that percentage of the associated expenses that you'd need to bear following the deductible.
If you have a 20% co-payment mentioned in your policy clauses...then you'd need to bear an amount equivalent of that percentage above your deductible. BarbieL
Posted: Fri Nov 21, 2008 06:06 am Post Subject:
It really depends on what you're looking for. HMOs, PPOs and Major Medical (indemnity, reimbursement) plans are all different, and a lot of the purchase decision should be based on the factors affecting all three delivery systems.
HMOs and PPOs have networks. HMOs typically lock you into the network unless you have an emergency, get a referral out of the network from your primary care physician, or have purchased a special type of HMO called a Point of Service Plan/Option. You'll pay a "co-pay" at the time of service which can vary depending on the service and provider.
PPOs by their very nature allow non-network access; you don't need a referral from your primary care doctor to go outside of the network and still have coverage. The key is the Preferred Provider part- they're designed to encourage network usage by the participant. The participant saves money, sometimes considerable amounts, by staying in the network. Go outside the network, you're covered, but you'll pay more. Normally, network providers charge the enrollee a co-pay, similar to an HMO, while non-network providers can mean higher co-pays or even a deductible and co-insurance.
Major Medical policies are "any provider" plans. You can choose any licensed provider, generally within a geographical area (U.S. and Canada, for instance) and the insurer will pay. There are deductibles and co-insurance (not co-pays) for plan usage.
As you can see from this basic info, there are differences just in the very basic stuff. It really boils down to what you need, can afford, and prefer.
InsTeacher 8)
Posted: Sat Nov 13, 2010 05:15 pm Post Subject: There are HMO and PPOs? What are they actually?
so i would like to understand something..the insurance company has ppo and hmo things (i'm not sure what to call them) and in them there are providers? if so can someone explain it to me fully so i can understand it?
is it true that insurance companies have something called hmo and ppo?
Posted: Sat Nov 13, 2010 05:25 pm Post Subject:
Hi Ins Teacher,
You stated
"It really depends on what you're looking for. HMOs, PPOs and Major Medical (indemnity, reimbursement) plans are all different, and a lot of the purchase decision should be based on the factors affecting all three delivery systems.
HMOs and PPOs have networks. HMOs typically lock you into the network unless you have an emergency, get a referral out of the network from your primary care physician, or have purchased a special type of HMO called a Point of Service Plan/Option. You'll pay a "co-pay" at the time of service which can vary depending on the service and provider.
PPOs by their very nature allow non-network access; you don't need a referral from your primary care doctor to go outside of the network and still have coverage. The key is the Preferred Provider part- they're designed to encourage network usage by the participant. The participant saves money, sometimes considerable amounts, by staying in the network. Go outside the network, you're covered, but you'll pay more. Normally, network providers charge the enrollee a co-pay, similar to an HMO, while non-network providers can mean higher co-pays or even a deductible and co-insurance.
Major Medical policies are "any provider" plans. You can choose any licensed provider, generally within a geographical area (U.S. and Canada, for instance) and the insurer will pay. There are deductibles and co-insurance (not co-pays) for plan usage.
As you can see from this basic info, there are differences just in the very basic stuff. It really boils down to what you need, can afford, and prefer."
So what you mean is that insurance companies have these hmo and ppo policies and the insurance companies use these hmo and ppo policies that have networks of providers that the insurance company uses to provide services to patients or insured people? I hope you understood what I asked..I hope it did not confuse you..I will go further after I understand it further.
thanks,
nick
Posted: Sat Nov 20, 2010 11:54 pm Post Subject:
these posts are very useful. So I understand that HMO and PPO are not the same thing. Good, I am getting somewhere.
Posted: Fri Nov 26, 2010 01:06 am Post Subject: Indemnity Health Insurance
From my experience, the indemnity plans are only for people with NO assets. The reason I say this is, on an indemnity plan it only pays a certain(low) amount towards certain conditions. If you come down with cancer/ heart attack or any major illnesses you will own $100k + in medical bills. If you only have small stuff happen to you then the benefits may better suit you! If you only had a crystal ball to tell you which you would get more use from. Also, I read a response that was describing the "20% Co-payment" That is wrong- She was referring to Co-Insurance which is normally 80/20% 20% is your responsibility up to a max out of pocket usually $2500 or so and the Ins company pays the 80% until your obligation is met then they pay 100% after the Deductible. A co-payment is on average $25. You pay this at the Doctors office for illness that can be handled in a Doctor's office the Insurance company pays the rest.On an injury that requires major surgery or anything that isn't routine or minor you will be looking at you deductible and co-insurance. E.G.. $10,000 bill for broken leg- $1500 deductible + 80/20% co-insurance up to $2500= 1500+1700(20% of the remaining $8500)= your responsibility $3200-
Posted: Fri Nov 26, 2010 09:23 pm Post Subject:
I would highly recommend to stay with a major medical plan instead of an indemnity plan. I tend to find indemnity plans are not very comprehensive. Most indemnity plans have application or enrollment fees. While Major medical plans do not.
Posted: Thu Nov 20, 2008 07:34 am Post Subject:
See..the HMOs and PPOs won't permit you to pick your preferred hospital or physician. In comparison, the indemnity policies would allow you to do so. They are the fee-for-service plans and hence offer you the option to pick your health care services. It would just cost you for the services through the life of your policy based on your policy specifications. Yupp, they could be a bit costlier at times ( as compared to the HMOs or PPOs) but you have a number of pay-back options.
Posted: Thu Nov 20, 2008 08:46 am Post Subject:
You may need to pay for the deductible. Once you pay for this amount, then you'd be eligible to receive the benefits promised in your sign-up papers. If you have not defaulted on your health care charges...and then come across an event which has been promised to be covered under your policy, you're bound to have it. So, you pay your deductibles and you won't need to worry about the rest. Crossbreed
Posted: Thu Nov 20, 2008 11:54 am Post Subject:
So, you pay your deductibles and you won't need to worry about the rest.
You may need to pay for a co-payment as well. This is that percentage of the associated expenses that you'd need to bear following the deductible.If you have a 20% co-payment mentioned in your policy clauses...then you'd need to bear an amount equivalent of that percentage above your deductible. BarbieL
Posted: Fri Nov 21, 2008 06:06 am Post Subject:
It really depends on what you're looking for. HMOs, PPOs and Major Medical (indemnity, reimbursement) plans are all different, and a lot of the purchase decision should be based on the factors affecting all three delivery systems.
HMOs and PPOs have networks. HMOs typically lock you into the network unless you have an emergency, get a referral out of the network from your primary care physician, or have purchased a special type of HMO called a Point of Service Plan/Option. You'll pay a "co-pay" at the time of service which can vary depending on the service and provider.
PPOs by their very nature allow non-network access; you don't need a referral from your primary care doctor to go outside of the network and still have coverage. The key is the Preferred Provider part- they're designed to encourage network usage by the participant. The participant saves money, sometimes considerable amounts, by staying in the network. Go outside the network, you're covered, but you'll pay more. Normally, network providers charge the enrollee a co-pay, similar to an HMO, while non-network providers can mean higher co-pays or even a deductible and co-insurance.
Major Medical policies are "any provider" plans. You can choose any licensed provider, generally within a geographical area (U.S. and Canada, for instance) and the insurer will pay. There are deductibles and co-insurance (not co-pays) for plan usage.
As you can see from this basic info, there are differences just in the very basic stuff. It really boils down to what you need, can afford, and prefer.
InsTeacher 8)
Posted: Sat Nov 13, 2010 05:15 pm Post Subject: There are HMO and PPOs? What are they actually?
so i would like to understand something..the insurance company has ppo and hmo things (i'm not sure what to call them) and in them there are providers? if so can someone explain it to me fully so i can understand it?
is it true that insurance companies have something called hmo and ppo?
Posted: Sat Nov 13, 2010 05:25 pm Post Subject:
Hi Ins Teacher,
You stated
"It really depends on what you're looking for. HMOs, PPOs and Major Medical (indemnity, reimbursement) plans are all different, and a lot of the purchase decision should be based on the factors affecting all three delivery systems.
HMOs and PPOs have networks. HMOs typically lock you into the network unless you have an emergency, get a referral out of the network from your primary care physician, or have purchased a special type of HMO called a Point of Service Plan/Option. You'll pay a "co-pay" at the time of service which can vary depending on the service and provider.
PPOs by their very nature allow non-network access; you don't need a referral from your primary care doctor to go outside of the network and still have coverage. The key is the Preferred Provider part- they're designed to encourage network usage by the participant. The participant saves money, sometimes considerable amounts, by staying in the network. Go outside the network, you're covered, but you'll pay more. Normally, network providers charge the enrollee a co-pay, similar to an HMO, while non-network providers can mean higher co-pays or even a deductible and co-insurance.
Major Medical policies are "any provider" plans. You can choose any licensed provider, generally within a geographical area (U.S. and Canada, for instance) and the insurer will pay. There are deductibles and co-insurance (not co-pays) for plan usage.
As you can see from this basic info, there are differences just in the very basic stuff. It really boils down to what you need, can afford, and prefer."
So what you mean is that insurance companies have these hmo and ppo policies and the insurance companies use these hmo and ppo policies that have networks of providers that the insurance company uses to provide services to patients or insured people? I hope you understood what I asked..I hope it did not confuse you..I will go further after I understand it further.
thanks,
nick
Posted: Sat Nov 20, 2010 11:54 pm Post Subject:
these posts are very useful. So I understand that HMO and PPO are not the same thing. Good, I am getting somewhere.
Posted: Fri Nov 26, 2010 01:06 am Post Subject: Indemnity Health Insurance
From my experience, the indemnity plans are only for people with NO assets. The reason I say this is, on an indemnity plan it only pays a certain(low) amount towards certain conditions. If you come down with cancer/ heart attack or any major illnesses you will own $100k + in medical bills. If you only have small stuff happen to you then the benefits may better suit you! If you only had a crystal ball to tell you which you would get more use from. Also, I read a response that was describing the "20% Co-payment" That is wrong- She was referring to Co-Insurance which is normally 80/20% 20% is your responsibility up to a max out of pocket usually $2500 or so and the Ins company pays the 80% until your obligation is met then they pay 100% after the Deductible. A co-payment is on average $25. You pay this at the Doctors office for illness that can be handled in a Doctor's office the Insurance company pays the rest.On an injury that requires major surgery or anything that isn't routine or minor you will be looking at you deductible and co-insurance. E.G.. $10,000 bill for broken leg- $1500 deductible + 80/20% co-insurance up to $2500= 1500+1700(20% of the remaining $8500)= your responsibility $3200-
Posted: Fri Nov 26, 2010 09:23 pm Post Subject:
I would highly recommend to stay with a major medical plan instead of an indemnity plan. I tend to find indemnity plans are not very comprehensive. Most indemnity plans have application or enrollment fees. While Major medical plans do not.
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