Health
insurance can be further classified into fee-for-service (traditional
insurance) and managed care. Both group and individual insurance
plans can be either fee-for-service or managed care plans.
The
following are types of managed care plans:
Purpose
The
purpose of health insurance is to help people cover their health care
costs. Health care costs include doctor visits, hospital stays,
surgery, procedures, tests, home care, and other treatments and
services.
Description
Health
insurance is available to groups as well as individuals. Government
plans, such as Medicare, are offered to people who meet certain
criteria.
Group
and individual plans can be further classified as either
fee-for-service or managed care. Cancer patients may have specific
concerns, such as the freedom to select specialists, that play a
factor in choosing a health care plan. Fee-for-service plans
traditionally offer greater freedom when choosing a health care
professional. Managed care often limits a patient to health care
professionals listed by the managed care insurance company.
Group
Health Plans
A group
health plan offers health care coverage for employers, student
organizations, professional associations, religious organizations,
and other groups. Many employers offer group health plans to
employees and their dependents as a benefit of working with that
particular employer (medical benefits). The employer may pay for part
or all of the insurance cost (premium).
When an
employee leaves a job he or she may be eligible for continued health
insurance as a result of the Consolidated Omnibus Budget
Reconciliation Act of
1986 (COBRA). This federal law protects employees and their families
in certain situations by allowing them to keep his or her health
insurance for a specified amount of time. The individual must,
however, pay a premium to keep their insurance plan in effect It is
important to note that COBRA only applies under certain conditions,
such as job loss, death, divorce, or other life events. The COBRA law
usually applies to group health plans offered by companies with more
than 20 employees. Some states have laws that require employers to
offer continued health care coverage for people who do not qualify
for COBRA. Each state's insurance board can provide additional
information.
Individual
Plans
These
type of health care plans are sold directly to individuals.
Fee-For-Service
Fee-for-service
is traditional health insurance in which the insurance company
reimburses the doctor, hospital, or other health care provider for
all or part of the fees charged. Fee-for-service plans may be offered
to groups or individuals. This type of plan gives people the highest
level of freedom to choose a doctor, hospital, or other health care
provider. A person may be able to receive medical care anywhere in
the United States and, often, in the world.
Under
this type of insurance a premium is paid and there is usually a
yearly deductible, which means benefits do not begin until this
deductible is met. After the person has paid the deductible (an
amount specified by the terms of the insurance policy) the insurance
company pays a portion of covered medical services. For example, the
deductible may be $250 so the patient pays the first $250 of yearly
covered medical expenses. After that he or she may pay 20% of covered
services while the insurance company pays 80%. The exact percentages
and deductibles will vary with each policy. The person may have to
fill out forms (claims) and send them to the insurance company to
have their claims paid.
People
who have cancer may be attracted to the freedom of choice that
traditional fee-for-service plans offer. However, they will most
likely have higher out-of-pocket costs than they would in a managed
care plan.
|
