Health insurance plans typically cover an array of services, including doctor visits, prescription drugs and hospital care. These benefits can be delivered in several ways:
- Indemnity plans typically have a deductible – the amount you pay before the insurance company begins paying benefits. After your covered expenses exceed the deductible amount, benefits usually are paid as a percentage of reasonable and customary expenses, often 80 percent. These plans usually provide the most flexibility in choosing where to receive care.
- Preferred Provider Organization (PPO) plans allow an insurance company to enter into contracts with selected hospitals and doctors to furnish services at a discounted rate. There is usually a higher deductible or co-pay if you seek care from a doctor or hospital that is not a preferred provider.
- Health Maintenance Organization (HMO) plans usually make you choose a primary care physician (PCP) from a list of network providers. Your PCP is responsible for managing your health care, including referring you to another doctor in the network if necessary. Treatment received outside the network is usually not covered, or covered at a significantly reduced level.
- Point of Service (POS) plans are a hybrid of the PPO and HMO models. They are more flexible than HMOs, but do require you to select a primary care physician (PCP). You can go to an out-of-network provider and pay more of the cost.
- Limited benefit plans provide coverage for a particular health care setting, ailment or disease.
What is NOT health insurance:
- Discount Plans are often advertised promising deep discounts on health care for a “low” monthly fee. Participants do not have the same protections they would have under licensed health insurance.
- Non-Licensed Risk-Sharing Plans invite you to join a group or association that will roll your monthly payments into a savings account, or trust, with other participants’ money, and then help pay some of your health care costs. Such arrangements are NOT authorized insurance plans and the participants do not have the protections available to purchasers of licensed insurance plans.
- Always verify before you buy – Contact the Connecticut Insurance Department 800-203-3447 or e-mail: insurance@ct.gov