HEALTH CARE PLAN
In relation to the Health Care Plans, this article is going to focus on the Managed Health Care Plan
Managed Health Care Plan
Managed health care plans allow plan sponsors to negotiate reduced rates for their policyholders with hospitals, medical service providers and physicians, by including them in the network.
They are a cost-effective alternative to traditional fee-for-service or indemnity health insurance plans because they share the medical cost financial risks between member individuals, and their insurance plans and members of the managed care network.
This plan also differs from traditional plans in that the members usually must select a “primary care physician” from the network of doctors provided by the plan sponsor. Being part of a network will provide plan members the advantage of access to services from network health service providers at set rates which reduce the costs of the plan.
Understanding Managed Health Care Plans.
Managed health care plan members benefit from reduced rates and guaranteed access to health care services.
Members of the health network benefit from having a steady stream of clients 2.
Plan Members have an easier time because when they work with providers in the network, they avoid having to file paperwork since the network members and medical service providers have billing systems. The HMO plan makes this the easiest.
Managed Healthcare Plans are types of health insurance plans that emerged in the latter part of the 20th century. It provides a health insurance policy to individual members of a group or employer. The group or employer is the plan sponsor of the managed care plan. A managed health care plan will help beneficiaries (members of the plan) by getting them more favorable rates or discounted medical insurance services from their plan’s health provider network.
Since the HMO Act passed in 1973, managed care plans became available to most Americans by the late ’80s and have since taken over as the most popular health insurance coverage in the United States.
Types of Managed Healthcare Plans:
Managed health care plans are an alternative to traditional health care plans like the formerly dominant fee-for-service plans.
In the past few decades, managed health care plans have become the more popular health insurance choice as health care costs have increased. The type of managed plan one has will dictate how to obtain medical services so it is worthwhile learning about them and how they work.
It is important to understand how managed health care insurance plan works so that one may know how much flexibility in medical services the plan will afford in the event that one needs to get medical care. HMO’s and PPO’s have their advantages but so do other plans like Indemnity Health Insurance Plans, which are not managed care insurance plans.
The types of Managed Health Care Plan are:
HMO: HEALTH MAINTENANCE ORGANIZATION
It provides employers or groups a way to take care of all their employees’ or members health care needs with reduced costs by negotiating with specific doctors, hospitals, and clinics. These specific providers must be used by the employee for the reduced fees to be provided to their medical insurance plan. In an HMO plan, a member has the least flexibility but will likely have the easiest claims experiences since the network takes care of putting in the claims for members.
PPO: PREFERRED PROVIDER ORGANIZATION
It offers reduced costs to members billed to their health insurance plan. Similar to an HMO, but the employees or members can choose the physician they want to see instead of being solely restricted to the HMO providers. A member can choose between a member or nonmember provider.
POS: POINT OF SERVICE PLAN
In this plan, members can choose their own physician that has previously agreed to provide services at a discounted fee. In a POS the member would have to use the chosen physician as a gateway first before moving on to a specialist. This means that whenever the employee would have a medical issue the POS physician must be contacted first in order to obtain the most benefit from the health insurance plan.
EPO: EXCLUSIVE PROVIDER NETWORK
The employee or member of this plan can choose from the providers within the network and do not have to work with a primary care physician. However, any service taken outside of the network may not be covered at all.
Medicaid and Managed Health Care Plans
As health services and health care plans have evolved, some states now offer Medicaid Managed Care plans. One can learn more about the state’s Medicaid program and whether it offers a managed care option by contacting the state insurance commissioner’ s office.
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The Advantages of Managed Health Care Plans: HMO (Health Maintenance Organization), PPO(Preferred Provider Organization) or POS (Point Of Service Plan) is that The managed health care plan proposition provides benefits to both plan members and sponsors.