NC Health Insurance Company

Choosing between family health care plans is not as simple as in the past. Although no plan will pay for every medical expense you come across, they do differ in what they offer for coverage. The majority of health care plans offer ways to keep down the costs of health care.

How do the health care plans differ from one another?

Indemnity insurance - Once you meet your deductible, most indemnity plans pay a portion of what is considered appropriate charges for covered services. The usual split of how much the insurer and insured pays is 80/20. You are responsible for the 80 percent and the insurance company pays the remaining 20 percent. The policy will also cover charges for lab and x-rays, prescriptions as well as care from doctors and hospitals.

Managed Care plans such as; Preferred Provider Organizations (PPOs) allow the insured to choose medical providers that may or may not be a part of the network. If you decide to use a doctor within the PPO network, you will be responsible for a copayment. If you go outside the network you are responsible for a larger percentage of the costs.

Health Maintenance Organizations (HMOs) offer members a variety of health benefits for a set monthly fee. HMOs provide   [continued below...NC Health Insurance Company]

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you with a list of doctors from their network so that you can choose a primary care physcian (PCP). When you have chosen your PCP, they will be the core of providing your medical needs. If you were to need a specialist you would first need to obtain a referral from your PCP. If you were to go to a physician outside of the network you would be responsible for the charges, unless of course you or a family member is in an emergency situation.

Point-of-Service (POS) Plans allow members to choose any doctor or hospital that they wish to attend and will still receive a form of coverage although not as comprehensive as the other insurance plans mentioned.

How to choose a plan

Remember that regardless of the plan you choose there will be sacrifices of some sort. So consider what you and your family need for medical coverage. Do you like the idea of your doctor being the one who has to refer you to a specialist or would you prefer to do this on your own? How much have you budgeted for out-of-pocket expenses, deductibles, and the premiums that you will be required to pay? Consider also any life changes that may apply; are you considering starting a family or are you closer to retiring? Does any member of your family have a pre-existing condition, if so this may affect certain insurance plans.