Long Term Care

Managed health care insurance is a type of pre-negotiated discounted medical coverage offered by employers to employees. There are basically three different types of managed health care plans: HMO's (Health Maintenance Organization), PPO's (Preferred Provider Organizations) and POS (Point of Service). The common element to these plans is the reduced monthly rate that the participant enjoys for loyalty to the managed care insurance provider. The differences are summarized below:

HMO: These services provide treatment on a prepaid basis to members who are required to pay the ongoing monthly fee. The reduced fee is a result of the employee negotiating with hospitals, clinics and physicians for the reduced fees. These medical services have stipulated conditions such as using specific providers.

PPO: These services involve supplying medical services to an allocated group. Unlike, HMO, PPO is not prepaid. PPO members pay for the services when they are required. Usually, employees can select the medical personnel they wish to use instead of being confined to pre-selected choices as stipulated by HMO. The PPO sponsor usually reimburses the employee for the cost of the treatment after deducting any co-payment fee. The prices for medical services are usually pre-established by negotiations by the PPO sponsor and health care providers.

POS: In this type of managed health care insurance, you do not incur a deductible fee and usually only contribute a small co-payment fee when you select a health care provider from within the network. You must use a primary physician as the first point of contact for all referrals. If you use medical service personnel outside of the network you will incur deductible and co-payment fees.

The choice of plans presents an interesting range of factors to consider before selecting managed health care insurance. If you have a preferred doctor and need access to certain specialists, you will need to understand whether they are included as part of the managed care insurance you are considering. Some plans may stipulate you use doctors that are not in close proximity or work only to certain hours. You will need to assess your requirements.

Other important factors to consider as part of a managed health care insurance plan include the extent of emergency coverage, prescription drug coverage and whether you are covered for regular health screenings. You may also require access to additional services such as drug and alcohol rehabilitation, counseling, alternative treatments and nursing home care. The best thing to do is to research the options and compare the extent of the coverage and flexibility. You will need to make a choice that suits your individual requirements.

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