Health Care Plans Available to Organizations

The Health Care Plans Available to Organizations are

  • Health Maintenance Organizations (HMOs)
  • Preferred Provider Organizations (PPOs)
  • Indemnity
  • Exclusive Provider Organizations (EPOs)
  • Point of Service (POS)

Indemnity

An indemnity health insurance plan allows the insured to choose the doctor, healthcare professional, service provider of their choice while allowing the greatest amount of flexibility and freedom a health insurance plan can offer (Araujo, 2020). The indemnity health policy stands out from other health policies such as health maintenance (HMO), and preferred provider organizations (PPO) by allowing the client to obtain medical attention from wherever they choose and providing compensation for specific costs. One of the most distinctive features of the indemnity health policy is that it does not force the client to seek medical care from a primary care provider (Araujo, 2020).

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Another special feature of the indemnity policy is that clients are allowed the freedom to self-refer to specialists and one does not need to get a referral so that they can be compensated. The kind of freedom and flexibility offered by this plan is valuable when one wants to direct their own health care plan (Milkovich et al., 2011). The freedom to direct one’s health care plan separates the indemnity health policy from other polices such as HMOs and PPOs which make use of managed care and may force a client to select primary care provider as a part of their healthcare plan (Araujo, 2020). One of the negative aspects of the indemnity plan is the fact that even though the plan pays for medical costs at the preferred medical care provider, all this is subject to a deductible (Araujo, 2020). A deductible is amount that one is required to pay before the benefits of the policy are provided.

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Preferred Provider Organizations (PPOs)

 A preferred provider organization (PPO) is an arrangement in medical care whereby medical professionals and health care facilities give access to services to subscribed clients at favorable and often discounted rates (Grant, 2020). In general, PPO medical and healthcare providers are referred to as preferred providers. A PPO is an organization that consists of medical professionals and facilities such as hospitals and the care of healthcare professionals (Grant, 2020). These professionals usually contract with insurance providers to give services to subscribed participants at an agreed reduced rate.

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In exchange for the reduced insurance rates, insurers pay the organization a fee in order to access providers. Provider and insurers engage in negotiations on then fees and schedules of services. Participants who are subscribed to the PPO are free to use the services of any provider they choose who is within their network (Grant, 2020). In the event that the insured wants an out-of-network provider, it would cost more for the client. The costs for the out-of-network provider are generally reasonable and if the claims exceed the reasonable and customary fees, coverage may not apply in such a case (Grant, 2020). In most cases where the costs exceed the reasonable fee, the excess fee is the responsibility of the patient. One of the disadvantages of PPOs is that they tend to charge higher premiums because they are expensive to administer and manage.

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