The Right Health Insurance How to find the right health insurance for your family.*

If you do not have medical insurance to help pay bills, a serious injury or illness can be financially devastating to you and your family. Even if you do have health insurance, too little or the wrong kind of coverage might still mean your family could suffer under the weight of medical bills.

What Types of Health Insurance Are Available?

Major Medical Plans

This type of policy is usually effective in covering serious illness or injury where costs are high. Hospital care, drugs and doctors’ visits are generally covered. These benefits can be delivered in several different ways:

Indemnity plans – These plans usually provide the most flexibility in choosing where to receive care and typically have a deductible; i.e., the amount you pay before the insurance company begins paying benefits.

Preferred Provider Organization (PPO) plans – In these major medical plans, the insurance company enters into contracts with selected hospitals and doctors to furnish services at a discounted rate. As a member of a PPO, you may be able to seek care from a doctor or hospital that is not a preferred provider, but you will probably have to pay a higher deductible or co-payment.

Health Maintenance Organization (HMO) plans – These major medical plans usually require you to choose a primary care physician (PCP) from a list of network providers. If you need care from any network provider other than your PCP, you might have to get a referral from your PCP to see that provider. You must receive care from a network provider in order to have your claim paid through the HMO. Treatment received outside the network is usually not covered, or covered at a significantly reduced level.

Point of Service (POS) plans – These major medical plans are a hybrid of the PPO and HMO models. They are more flexible than HMOs, but require you to select a primary care physician (PCP). Like a PPO, you can go to an out-of-network provider and pay more of the cost.

Limited Benefit Plans

These types of policies provide limited coverage for a particular health care setting, ailment or disease. Here are some of the options that might be available to you:

Basic Hospital Expense Coverage – Covers a period of usually not less than 31 days of continuous in-hospital care and certain hospital outpatient services.

Basic Medical-Surgical Expense Coverage – Covers costs associated with a necessary surgery, including a certain number of days (usually not less than 21 days) of in-hospital care.

Hospital Confinement Indemnity Coverage – Covers a fixed amount (usually not less than $40) for each day that you are in a hospital. The benefits paid are not based on your actual expenses.

Accident Only Coverage – Covers death, dismemberment, disability or hospital and medical care caused by an accident. Specified accident coverage that covers only certain accidents may also be purchased.

Specified Disease Coverage – Covers diagnosis and treatment of a specifically named disease or diseases; such as cancer.

Other Limited Coverage – You may purchase insurance covering only dental or vision or other specified care.

Discount Plans and Risk-Sharing Plans

Discount plans and risk-sharing plans are not insurance plans! Before signing, be sure to understand how the program works, and what benefits it offers you or your family.

Discount Plans – You might receive advertisements from plans offering discounts on health care for a monthly fee. These are not health insurance plans and participants do not have the same protections as under licensed health insurance plans. Insurance commissioners strongly recommend that you thoroughly investigate any plan promising deep discounts for a “low” monthly fee and weigh the benefits against the cost carefully.

Non-Licensed Risk-Sharing Plans – You may receive offers to join a group or association that will take your monthly payments, put them in a savings account (or trust) with other participants’ money, and then help pay some of your health care costs, as needed. Such arrangements are not insurance and the participants do not have the protections available to purchasers of licensed insurance plans. State insurance regulators strongly recommend that you thoroughly investigate such plans before joining.

*Article content from NAIC