Types Of Medical Plans

In the US alone in 2006 around 52% of private sector workers were covered by medical plans provided by their employer. Generally the fees that are paid for these particular plans fall in to two categories, either indemnity or prepaid.

An indemnity medical plan is one in which the patient or the provider of the medical plan will find that they get reimbursed for their expenses as they happen. Whilst a prepaid medical plan such as those provided by HMO's (Health Maintenance Organizations) the person enrolled on them will pay a set fee for this medical plan even if they do not incur any costs for medical treatment. Around 55% of all the people taking part in a medical plan where they work are covered by the indemnity version whilst around 29% of all other workers are covered by a prepaid plan.

Unfortunately there are some restrictions in relation to prepaid medical plans which may provide a reason as to why so few employees are actually using this type of service. The restrictions relate to their choice of service provider. They can either use a medical service which has been specifically enrolled as part of the prepaid plan service and is the only one that an employee on a prepaid plan is able to use or they may be able to use another medical service. The only problem is that they may be asked to contribute towards the costs of actually have any treatment carried out by them.

Whilst those who are covered by an HMO medical plan will find that doctors visits, along with any time that they need to spend in hospital, as well as any operations (be they minor or major) plus other healthcare services will be provided by members of these plans. In most cases the services that are provided on an HMO plan will be managed by a primary care provider who is also to be found to be contracted to HMO. However a person is entitled to change from one healthcare service to another as long as they are still part of the HMO member network. Unfortunately should a person decide not to use the services provided through their HMO medical plan they may well discover that the costs of any treatment are not covered by them. However, there are some exceptions to this and one is when the medical services have previously been authorized as being available to use by the primary medical provider who is part of any HMO medical plans.

Privacy Policy