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health insurance

HEALTH INSURANCE COVERAGE

Health Insurance Policy provides coverage for medicine, visits to the doctor or emergency room, hospital stays and other medical expenses. Policies differ in what they cover, the size of the deductible and/or co-payment, limits of coverage and the options for treatment available to the policyholder.

Health insurance can be directly purchased by an individual, or it may be provided through an employer. Medicare and Medicaid are programs which provide health insurance to elderly, disabled, or un-insured individuals. As an Authorized Agent First Knight Insurance has a variety of companies which provide health insurance, including Blue Cross, Blue Shield, United Healthcare, Aetna, Kaiser Permanente. Choosing the right plan is an important decision and we want to ensure that you get the type of health insurance coverage you need.

Call FIRST KNIGHT INSURANCE today if you have any questions regarding Health Insurance Plans and Rates. We can give a professional advice and accurate quote from National leading Insurance Companies such as Anthem Blue Cross, Blue Shield, Kaiser Permanente.

CHOOSING HEALTH INSURANCE COVERAGE

Consider the following features when comparing health care coverage. How much will you pay out-of-pocket?

  • Deductible: This is the initial dollar amount you must pay before your insurance company begins paying for health services. Usually, the higher the deductible, the lower your premium. However, do not choose a deductible so high that you cannot afford to pay it. The contract will dictate the specific amount you pay per year for your family. You must pay a deductible each year, which will vary depending on the number of people covered by the policy.
  • Coinsurance: Coinsurance is the share or percentage of covered expenses you must pay in addition to the deductible. For example, your policy may pay 80 percent of covered charges after you pay the deductible. You would then pay the remaining 20 percent as coinsurance.
  • Co-payment: A co-payment is a specified dollar amount you pay, as a subscriber to a managed care plan, for covered health care services. It is paid to the medical provider at the time the services are rendered.
  • Premium: The monthly or annual amount you will pay for your insurance policy. Coordination of Benefits
  • Provision: Even if you have more than one group policy, you cannot receive more benefits than your actual hospital and medical expenses. Even if a husband and wife each have family coverage under separate group policies, they cannot collect on the same claim twice, even if they have paid two premiums.
  • Renewal and Premium Increase Provisions: These provisions determine the conditions under which you lose your eligibility, without a medical exam to prove you are in good health.

Basic Difference Between PPO & HMO PLANS:

  • The HMO or Health Maintenance Organization comprises in a network of physicians and health facilities that are contracted to provide medical care to the HMO members. Under this plan *You are required to choose one primary care physician who directs your care.*You are limited to using in-network doctors and hospitals except in an emergency or by referral from your primary care physician. *You need to make a co-payment (a flat fee you pay for each doctor visit).
  • The PPO or the Preferred Provider Organization Plan also uses a network of physicians and medical facilities. However, unlike the HMO, you have the option of using an out-of-network health care provider or facility without prior approval. In this case, however, you will have less coverage and may have to foot part of the bill. *An annual out-of-pocket deductible applies before your insurance company begins to pay for your medical care. *Co-insurance applies. This is a preset percentage of the covered costs that you must pay out of pocket.

Features and Benefits:

  • HMO Plan

*This tends to be the least expensive of all the group health plans.
*It offers the lowest out-of-pocket costs, as there is no deductible or co-insurance required.
*There is a focus on preventive health care through wellness programs and other similar initiatives.
*There is a risk that you may not get the healthcare services you require because of the strict restriction on using in-network providers.

  • PPO Plan

*A PPO offers your employees greater choice and freedom while controlling healthcare costs.
*There is greater access to specialists who may only be available from out-of-network providers.
*Using an out-of-network provider effectively reduces your coverage, costing you more out-of-pocket.
*It is difficult to estimate your out-of-pocket expenses.

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