Most people would like their employer to provide group health insurance coverage for them. But due to whatever reason, if this option is not available for you, it is still important for you to seek coverage using individual or family medical insurance plan. You will discover that there are many options available to improve your family health insurance coverage.

Types of family medical insurance plans
Individual and family health insurance plan are normally classified as “indemnity” or “managed-care” plans. The major differences include choice of healthcare providers, out-of-pocket costs and how bills are paid. In Indemnity plans you typically pay up front and obtain reimbursement from the insurance company. Indemnity Insurance plans generally provide a wider choice of health care providers than managed care. Managed-care plans make use of a network of healthcare providers. Healthcare providers within a network provide services at pre-negotiated rates and will usually submit the claim on your behalf to the insurance company. It is less paperwork and lower out-of-pocket costs. This helps keep family medical insurance rate under check.

Types of Managed care plans
Managed Family medical insurance plan may be broadly classified as HMO, PPO, and POS plans.

If your family health plan is a PPO (Preferred Provider Organization) plan, you are expected to use a network of preferred doctors and hospitals. They provide services at a discounted rate. If you use services from an out-of-network physician, it is typically covered at a lower percentage than services rendered by a network physician.

HMO (Health Maintenance Organizations) plans typically offer less flexibility in the choice of physicians or hospitals. You will have to choose a primary care physician (PCP) and your PCP will attend to most of your healthcare needs. Specialists will have to be referred by your PCP.

POS (Point of Service) plans combine the features offered by HMO and PPO plans. Like in the case of an HMO, you will be required to choose a primary care physician (PCP) from the plan’s network. PCP’s services are normally not subject to a deductible. Also, like HMOs, POS plans offer coverage for preventive care.

However, you will receive a higher level of coverage for services rendered or referred by your PCP. Services rendered by a non-network provider will generally be subject to a deductible and covered at a lower level. If services are rendered outside of the network, you may have to pay up-front and get it reimbursed.

Indemnity plans
A typical Indemnity plan offers a more freedom in choice of doctors and hospitals at a higher out-of-pocket cost and more paperwork. Under an Indemnity plan, you can consult whatever doctors or specialists you like, without any need for referrals. However, this freedom comes at a cost. You may be required to pay an annual deductible before the insurance company begins to pay on your claims. The insurance company typically uses a “usual, customary and reasonable (UCR) rate” for the service. It is the amount that healthcare providers in your area typically charge. You may have to pay up front and get it reimbursed.

Health Savings Account
Health Savings Accounts (or “HSAs”) is a tax-friendly savings account. HSA in conjunction with an HSA-compatible high deductible health insurance plan can be used to pay for qualifying medical expenses.
An HSA-compatible health insurance plan can help save money. Typically, the monthly premium on an HSA-compatible high deductible plan is less expensive than others. Contributions can be made pre-tax, up to certain annual limits. HSA funds can be invested at your discretion. Interest earned in HAS account is tax-free.

Co-pay
A “co-payment” or “co-pay” is a specific charge some family health insurance plans may expect you to pay for certain medical service or purchase. For example, you may be required to make a $15 co-payment for a visit to a physician or a specified prescription drug, after which the insurance company will make good the rest of the charges. While considering the family health insurance rate, it is important to keep co-pay in mind.

Deductible
A “deductible” is a specific amount that your family medical insuranceplanprovider may require that you pay out-of-pocket each year before your health insurance plan begins to make payments for claims. Deductibles are required by all health insurance plans. Generally, HMO plans do not require a deductible, while most Indemnity and PPO plans do.

Coinsurance
Coinsurance is a term used to refer to the amount that you are expected to pay for a medical claim. This is in addition to any co-payments or deductible. For example, if your health insurance plan involves a 20% coinsurance requirement and if there is no CO-Payment or deductible requirements, then a medical bill of $100 would cost you $20, the insurance company paying $80.

Some considerations while choosing individual and family health insurance plan
There is no single “best” plan for everyone. The best plan for you and your family may be different than the best match for someone else. While considering a family health insurance quote, it is useful to keep in mind the following factors

1. Long term Vs short term: If you are unlikely to get into a job and hence a group plan, choose a long term plan.
2. Basic coverage Vs comprehensive coverage: The plans offer basic services like inpatient hospitalization and outpatient surgery to comprehensive benefits including preventive care, physician service, prescription drugs.
3. Pay for service before using them or when you use them: The higher the monthly premium, the less you pay per doctor’s visit in copayment and deductibles.
4. Access to specialists: Some plans provide easier access to specialists than others.
5. How much you can pay “out of packet”: Health insurance plans typically place limits to how much you are required to pay as maximum out-of-packet.

With increasing complexity while deciphering your family health insurance quotes, obtain all details from your agent to get the best health insurance for family.

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