Colorado Marine Officer

Posts Tagged ‘Types of Group Health Insurance Policies’

· Long-Term Care
This policy usually pays for skilled, intermediate and custodial care in a nursing home. It usually pays a fixed amount per day while a person is in a nursing home. Most policies contain elimination periods, during which no benefits are paid. Some policies also cover alternative types of care such as home health care or adult day care. Some even cover home modification expenses. Normally, these policies pay only for expenses in facilities that are licensed by the state and/or participate in Medicaid and Medicare, and meet the policy’s definition of skilled, intermediate or custodial care. For this reason, it is important to find out about the types of nursing homes that are in your area before you buy the policy.

· Health Maintenance Organizations (HMOs)
These organizations provide health care services directly to their members, who pay a fixed monthly fee to the HMO. These services include such things as hospital care, surgery and routine office visits. The HMO is an alternative to traditional health insurance because it provides actual services rather than just reimbursement for health care expenses. Enrollees usually pay a small co-payment for care or services they receive. There are various ways that HMOs can be set up. Some HMOs employ their own physicians, who treat patients at an HMO center. Others contract with individual physicians or groups of physicians. Patients are treated at the physicians’ offices or health centers. Usually, HMO members must receive health care treatment at a designated hospital, HMO facility or from physicians who contract with the HMO. Before you pay a fee to join an HMO, ask questions about how it works and where you would receive care, and talk to people who belong to it. Consider whether you will have to stop seeing a particular physician and choose another.

· Preferred Provider Organizations (PPOs)
Under this program, an insurance company enters into contracts with selected hospitals and doctors to furnish services at discounted rates. As a member of a PPO, you might 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.

· Point of Service (POS)
This plan combines the benefits of an HMO and traditional health insurance. Enrollees can use providers in the HMO for
a nominal co-payment or seek care outside the HMO network where a deductible and a share of the expenses, often 20 percent to 30 percent, may have to be paid.

. Major Medical Expense
This type of policy is usually effective in covering serious illness or injury where costs are high. Expenses you incur both in and out of the hospital, including drugs and doctors’ visits, usually are covered. Most major medical plans contain a deductible — the amount you pay before the insurance company begins paying benefits. After your expenses exceed the deductible amount, benefits are paid as a percentage of actual expenses, often 80 percent.

· Disability Income Protection
This coverage provides for weekly or monthly benefit payments while you are disabled after a covered injury or sickness. The disability payment is usually a set dollar amount not to exceed a certain percentage of your income. Usually the most you can qualify for is approximately 60 percent of your gross earnings.
Be aware that some disability income policies contain an elimination period, measured from the start of each disability.
During that time, no benefits are paid. Elimination periods vary, generally from 30 days to six months, depending on the policy. A longer elimination period may provide lower premium payments.  Also, many disability income policies reduce benefits based on other income to which you may be entitled, such as sick leave pay, disability retirement income, and Social Security disability benefits.

· Accident Only Coverage
This policy covers losses due to an accident. Benefits vary greatly. Coverage may be provided for death, loss of limb or
sight, disability, or hospital and medical care.

· Specified Disease or Specified Accident
Some policies cover a specific disease, such as cancer, or a specific kind of accident, such as while traveling away from home. Benefits are not paid for any other sickness or injury. The benefits may be based on your actual medical xpenses
or payable as a lump sum indemnity.

· Medicare Supplement
The federal Medicare program pays most medical expenses for people 65 or older, or for individuals under 65 receiving Social Security disability benefits. However, Medicare does not pay all expenses. As a result, you may consider purchasing a Medicare Supplement policy that helps pay for certain expenses, including deductibles not covered by Medicare.