That's because complex rules and regulations have been developed for defining what's covered, and for actually paying the bills. While these mechanisms have been created, in part, as a way of preventing fraud, they also serve as a buffer to protect the insurance companies' bottom lines.
Most health care policies provide payment for service. That means the amount the insurer pays is based on the cost of the service, such as a doctor's visit or hospital stay. Indemnity plans, on the other hand, guarantee that they'll pay a specific amount per claim--$100 for every day you're in the hospital, for example. In general, they're not a smart use of your insurance dollar, even though the coverage is cheap. That's because the amount they pay often covers only a fraction of the actual cost of any care you recieve, and the conditions under which they will pay are usually more restrictive than they seem when the policy is sold.
Indemnity Health Plan
DEFINITION: Indemnity health insurance plans are also called fee-for-service. These are the types of plans that primarily existed before the rise of HMOs, IPAs, and PPOs. With indemnity plans, the individual pays a pre-determined percentage of the cost of health care services, and the insurance company (or self-insured employer) pays the other percentage. For example, an individual might pay 20 percent for services and the insurance company pays 80 percent. The fees for services are defined by the providers and vary from physician to physician. Indemnity health plans offer individuals the freedom to choose their health care professionals.
Some insurers, especially non-profit Blue Cross and Blue Shield plans, have annual open enrollment periods, during which insured people can switch carriers, and people without insurance can apply. All applicants qualify for coverage during this period, even it they might be turned down the rest of the year. The insurer, however, my charge some applicants higher rates if they're in poor general health or have a real live life threatening serious illness.
Workers' compensation. Dangerous tasks are common in the construction workplace Workers' compensation is a form of insurance providing wage replacement and medical benefits to employees injured in the course of employment in exchange for mandatory relinquishment of the employee's right to sue his or her employer for the tort of negligence.
The tradeoff between assured, limited coverage and lack of recourse outside the worker compensation system is known as "the compensation bargain". General damage for pain and suffering, and punitive damages for employer negligence, are generally not available in workers' compensation plans, and negligence is generally not an issue in the case. These laws were first enacted in Europe and Oceania, with the United States following shortly thereafter. Statutory compensation law These laws also provide benefits for dependents of those workers who are killed because of work-related accidents or illnesses.
Workers' compensation fraud Remote injury. Underreporting payroll. Affordable Health Insurance For Families. What Is Third-Party Insurance? : Insurance Questions. America's Health Insurance Plans - AHIP. Health Insurance Made Simple. Individual Health Insurance Quotes. Individual & Family Health Insurance Quotes. Get the insurance that's right for you.
High, low and no deductible plans available Coverage for the everyday and the unexpected Flexibility to add dental insurance to your health plan View plans Let us help you find the right plan. Health Care Reform Learn more about health care reform and how it affects your coverage. Contact Us Speak to a customer care specialist who can walk you through your current plan or help with additional coverage options. Regular dental care could mean better overall health. As a small business owner, you want to offer great benefits while keeping costs down. State Farm Health Insurance Individual Health Plans. Long-Term Care Insurance (LTC) - John Hancock. Long-term care (LTC) insurance is important coverage that provides valuable support and financial resources that help cover the cost of long-term care you might need in the event of an illness, accident, or through the normal effects of aging.
By helping to protect your assets, and giving you choice and control over where you receive care—including in your home—LTC insurance helps you and your family face the future with confidence. HMO: Health Maintenance Organization. A health maintenance organization (HMO) is an organization that provides or arranges managed care for health insurance, self-funded health care benefit plans, individuals, and other entities in the United States and acts as a liaison with health care providers (hospitals, doctors, etc.) on a prepaid basis.
The Health Maintenance Organization Act of 1973 required employers with 25 or more employees to offer federally certified HMO options if the employer offers traditional healthcare options. Unlike traditional indemnity insurance, an HMO covers care rendered by those doctors and other professionals who have agreed by contract to treat patients in accordance with the HMO's guidelines and restrictions in exchange for a steady stream of customers.
HMO: Blue Cross Blue Shield of Texas - Health Insurance Texas - BCBSTX. PPO: Preferred Provider Organization. In health insurance in the United States, a preferred provider organization (or PPO, sometimes referred to as a participating provider organization or preferred provider option) is a managed care organization of medical doctors, hospitals, and other health care providers who have agreed with an insurer or a third-party administrator to provide health care at reduced rates to the insurer's or administrator's clients.
Overview A preferred provider organization is a subscription-based medical care arrangement. A membership allows a substantial discount below the regularly charged rates of the designated professionals partnered with the organization. Preferred provider organizations themselves earn money by charging an access fee to the insurance company for the use of their network (unlike the usual insurance with premiums and corresponding payments paid either in full or partially by the insurance provider to the medical doctor). PPO See also References The Differences Between Cigna Open Access and PPO.
Understanding Your Health Benefits FAQs. Where can I find out what my coverage or copay will be for certain procedures?
You can find coverage and copay information in your Summary of Benefits booklet. Your copay amount may also be listed on your Member ID card. If you can't find what you need from either source, please contact Member Services at the toll-free number on your Member ID card or send an e-mail to Member Services. PPO: Workers Compensation (Workers Comp) Insurance. You pride yourself on operating a safe, secure work environment where your employees can perform to the best of their ability while helping your business grow.
Even in the most ideal circumstances, the reality is that accidents and illness still happen. A slip and fall at a restaurant resulting in broken bones, an equipment malfunction at a construction site causing eye injury—it could be any number of things. Upon the unexpected, it's essential that your employees' medical needs are quickly addressed so they can return to work as fast as possible. And that's exactly what Farmers can help you do.
Let a Farmers agent create a tailored, multi-covered solution, including Workers' Compensation Insurance that meets the specific needs of your business. Rely on experts who know workplace injury. Managed Care: MedlinePlus.