 770-396-9517 call toll-free: 1-877-711-8376 |
||
|
|
||
|
770-396-9517 call toll-free: 1-877-711-8376 |
||
|
|
||
What is the difference between Georgia
indvidual Open Access POS health insurance and other types of
Georgia individual health insurance plans?
Before we begin to try to understand
the different types of Georgia health insurance, there is a bit
of information we need to be familiar with. All insurance plans
have certain things in common. It would be helpful to understand
what they are so you can see how they apply to each type of insurance.
Network - A group of providers, doctors, hospitals, labs, etc. that have a relationship with the insurance company and have established specific pricing for services. This is the way that insurance companies manage their costs.
Out of Network - An out of network provider is any physician, hospital, lab, etc. who does not participate (or "accept") your insurance plan. In the event that you utilize one of these providers, your "out of network" benefit would apply, if your plan includes an out of network benefit.
Deductible-This is the portion of any health charges that you pay before the insurance company pays anything (many plans waive the deductible for physician office visits, instead using an office visit co-pay). ALL plans have a deductible. It may be vary form $0 to $10,000, but it's always included in the plan benefits.
Coinsurance- After the deductible is met, you enter into a period of coinsurance. It's just what the name says. Two entities are paying the health costs during the coinsurance period. When you see the term 80/60 it means that if you stay in network, you pay 20% and the insurance company pays 80% of the charges. Out of network, you pay 40% and the insurance company pays 60%. There is normally a stop loss of $1000 or more that the insured has to pay. In other words, if your plan reads 80/20 through $5000, you would be responsible for 20% of $5000 after the deductible has been met. Then the insured's liability would stop and the insurance company would pay the rest.
Not all plans have coinsurance. Often, you won't find coinsurance in an HMO plan, and often it won't be in an H S A eligible plan.
After the deductible and coinsurance have been met, the insurance company has the liability of any other covered health charges during the plan year.
Now that you have a general definition of insurance terms, let's look at the different types of plans.
The term POS stands for Point of Service (meaning, your amount of benefit depends on the point of service, i.e. in or out of network). Open Access POS health insurance plans are designed to work in a similar manner to a POS insurance plan with the additional option of utilizing out of network providers. So, let's start by reviewing POS plans.
A POS plan is the broadest type of health coverage available. The deductible can be as low as $0 and many companies offer plans with no coinsurance.
Normally, a POS has a co-pay for most services. The reason we say this is the most comprehensive coverage is that the co-pay covers most of the service that the physician or lab charges. When you go for an office visit, it's all-inclusive in most cases. Sometimes there is even a co-pay for a hospital stay or outpatient surgery. If you encounter coinsurance on a POS plan, it usually will be in conjunction with a deductible for the hospital stay. POS plans usually fully cover the cost of physicals, where the other plans normally have a limit to what they will pay for a physical. A traditional POS plan requires that the insured member get a referral before going to see a specialist with the exception of a Dermatologist, a Psychiatrist, and/or an OB/GYN specialist. There is also an "out of network" benefit in the event that you see a provider who does not accept your insurance plan.
The big difference in an Open Access POS health insurance plan is that the member is not required to get a referral to see a specialist, however, the specialist must be in the network in order for health insurance benefits to be paid as an "in network" benefit. Otherwise, out of network benefits will apply which are usually less benefit and mean that the insured pays more out of their pocket.
Advantages-The POS offers the broader coverage
with less out of pocket costs during the plan year. It also has
an out of network benefit.
Disadvantages-Primarily less choice in doctors
and hospitals to utilize in-network benefits. However, with the
increasing popularity of the POS and Open Access POS plans, more
physicians, hospitals, labs and other providers are now contracting
to accept POS plans which gives much more choice to the insured.
Here are some of the other types of insurance
plans that are available in Georgia:
HMO
Individual and Group Health Insurance
Plans
Open Access HMO Individual and Group
Health Insurance Plans
POS
Individual and Group Health Insurance Plans
PPO
Individual and Group Health Insurance Plans
H S
A Individual and Group Health Insurance Plans
Indemnity
Individual and Group Health Insurance Plans
We hope this information is helpful to you. If you would like further information or have questions, please feel free to contact us at Insurance Now and we will spend whatever time is needed to help you make sure that you select the right plan for you.
|
5 Dunwoody Park South Suite 113 Atlanta, GA 30338 |
(770) 396-9517 Outside of the Atlanta area, call toll-free: 1-877-711-8376. fax: 770-396-4318 Email: holly@insurance-now.com |
 |