Shaheed Nagar Crossingagra , 282001
Email AddressInformation Not Available
Awards and AchievementsInformation Not Available
Areas of SpecializationGeneral Hospital
Other Hospitals in Agra
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Apollo Pankaj Hospitals Ltd
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Asopa Hospital & Research Centre
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Pareek Hospitals P) Ltd.
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People's Heritage Hospital Ltd
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Pushpanjali Hosptial & Research Centre
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Ram Raghu Hospital
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Shree Ram Hospital
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Location: Shaheed Nagar Crossingagra , 282001
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Tip of Day
Health insurance types - Get to know the crux of each type
Basically, there are two types of health insurance Plans: One being Fee for Service health Insurance, and the other Managed Care Health Insurance. While differing from each other, both these Plans cover prescription drugs, dental care, and also medical, hospital, and surgical costs. This article tells you in detail about:
- Which are the two major types of health insurance?
- What are the subdivisions that come under the managed care plans?
- What are the features of point of service?
Should you require your health care costs covered at a reasonable price, you have to accord medical insurance top priority- taking into account the spiraling expenses in health care and the consequent pressure on medical insurance premiums. Basically, there are two types of Health insurance plans: One being Fee for Service health Insurance, and the other Managed Care Health Insurance. While differing from each other, both these Plans cover prescription drugs, dental care, and also medical, hospital, and surgical costs.
Fee for Service
In these plans, the insured patient is examined by a doctor chosen by him, and the medical professional receives a fee for each service given to the insured patient. The fee- for -service health insurance claim is filed either by the patient or the medical provider.
Managed Care Health Insurance Plan
- The PPO Plan or the Preferred Provider Orgnisation
- The HMO Plan or the Health Maintenance Organisation
- The POS Plan or the Point of Service Plan
The HMO Explained
The Health Maintenance Organisation is the oldest form of organized health care. For a predetermined cost, the HMO gives its members a choice of a wide variety of health care benefits- preventive care included. Among the HMOs a prospective member could choose from:
- A Group Model HMO where doctors are employees of the health plan, and in which case the member of the HMO would be visiting them at centralised clinics or medical centres.
- The Individual Practice Associations or IPAs whereby the HMOs would have entered into contracts/agreements with groups of physicians or individual doctors who would be consulting in their private offices.
In the event that the enrollee of the HMO requires a specialist's services, he would need to coordinate with the primary care physician or PCP referred to him by his HMO. In most HMO plans, this would include the concept of copayment, with reference to medical services provided- and this is inclusive of hospitalisation and office visits. Here, the insured member of the Plan would pay his medical service provider a predetermined sum of money for that particular visit .After the copayment(an expense-sharing agreement in which the insured pays a particular amount for a certain type of medical service) has been effected, most costs as a result of that visit would be covered. This is exclusive of lab tests.
What Is Meant By PPO?
The Preferred Provider Organization is a type of organized health care that:
- Enters into contractual agreements with hospitals and other medical service providers who would be charging their services for a lesser fee to the insurers.So if you choose to utilize the medical services of a provider from outside the PPO network, your cost-sharing would be much higher than if you were to see a doctor from within.
- Which brings us to another notable feature of the PPOs- which is the freedom for the insured to make self referrals, consulting with medical service providers, from outside the PPO network. However you would be reimbursed for only 70% of the cost by the insurer. Additionally the member of the PPO health insurance plan would have to meet the difference in charges-between what the plan offers and what the provider charges.
Questions to Ask About a PPO
- How many doctors are there to choose from?
- Who are the doctors who come within the folds of the PPO netwok?
- And where exactly are they located?
- Which of these doctors would be accepting new patients?
- What is the method by which referrals are handled?
- Which hospitals are made available through the PPO health insurance Plan?
- In emergency healthcare situations, what arrangements has the PPO done?