What Choices Are Available in Group Health Care Insurance
Choosing a health care policy is an important choice and is sometimes one that is limited by the group health care insurance that is provided by the person's employer, professional organization or union. Group health care insurance can be a positive choice because the rates of these plans are often less expensive than individual health care insurance since the employer or organization gets a group rate from the insurance company on the plan for having so many people on it. In addition, the group health care insurance plans can be less expensive to the user because the employer or organization will often pay a part of the premium if their employee or member uses that particular health care plan rather than getting a private plan, which benefits the individual.
Types of Group Insurance
There are different types of managed care plans for group health care insurance policies. HMO, or health maintenance organizations, is a plan in which the individual must obtain all of their health care from a list of approved providers that participate in that HMO. In order to go to any specialists the individual must get a referral from his primary care physician or the insurance company will not pay for the claim. There are often other rules that apply to after hour care and emergency care with these types of plans.
A PPO, or preferred provider organization gives an individual a little more flexibility in choosing providers for their health care in group health care insurance. Under a PPO, the individual may choose to use a provider that is not within the list of approved providers and still have the PPO cover the expenses according to the policy they bought. However, the providers that are on the list are less expensive to use than those that are not, so although the individual has the choice, he will usually choose providers on the list to reduce cost to himself in out-of-pocket expenses.
One other plan in group health care insurance is a point-of-service plan or POS. In this type of plan, it is the primary care physician that organizes the care for the patient, including any specialists that are needed to treat certain health care needs. It also is a more flexible plan than an HMO and is very similar to a PPO.
The main issues that an individual should be concerned with in choosing which group health care insurance option they want (provided that the company offers a choice) are what access the plan provides to various doctors, hospitals and other providers such as chiropractors, and what the after hour or emergency procedures are, should those types of situations happen.
