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Health Insurance Plans

Health Insurance Plans. Ashley & Lee Willis April 24, 2007. What is a Health Maintenance Organization? (HMO). In order to receive the benefits of an HMO an individual must pay a fixed monthly amount . With an HMO plan one may choose a primary care physician from an approved list of doctors.

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Health Insurance Plans

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  1. Health Insurance Plans Ashley & Lee Willis April 24, 2007

  2. What is a Health Maintenance Organization? (HMO) • In order to receive the benefits of an HMO an individual must pay a fixed monthly amount . • With an HMO plan one may choose a primary care physician from an approved list of doctors. • An individual may not visit other specialists without the consent of their primary care physician • Visits to doctors or specialists who are not approved through the primary care physician, or who are not on the approved list, will not be covered. • Most visits require a co-pay ranging from $5-20. (http://www.healthinsuranceindepth.com/policy-types-hmo.html)

  3. What is a Preferred Provider Organization? (PPO) • In order to be a part of a PPO an individual must pay a monthly fee that will then allow them their choice of providers, and a network of basic medical benefits. • With a PPO a primary care physician is not required, and as a result, seeing a specialist does not require a referral. • If an individual prefers to receive health care outside the providers offered, they should expect to pay a higher co-payment than if the provider were from within the PPO network. • Essentially a PPO provides an individual the freedom of choice when visiting a doctor or specialist by cutting out the middle man. http://www.healthinsuranceindepth.com/policy-types-ppo.html

  4. What is a Health Savings Account? (HSA/HDHP) • Health Savings Accounts (HSAs). A personal tax-exempt trust account designed for the purpose of paying for medical expenses. • Money is contributed by individual and employers tax free • Users can only qualify for an HSA if they are enrolled in a High Deductible Savings Account (HDHP) • Money in an HSA account can be used for "qualified medical expenses" which include: expenses for "diagnosis, cure, mitigation, treatment, or prevention of disease." (Tech Ex p. 73) • The money in an HSA can provide coverage during periods of unemployment, medical expenses after retirement and long-term care expenses. http://www.nahu.org/legislative/HSAChangesChart.pdf

  5. Problems Getting Care Source: Consumer Reports

  6. Billing Hassles • HMO – 15% of holders reported having billing problems • PPO – 32% of holders reported having billing problems • HSA/HDHP – No billing hassles Source: Consumer Reports

  7. Cost Analysis • Top five expenses Americans incur each year • Health Care Expenses increase annually almost 10% • Employers will be unable to subsidize the cost of Health Care

  8. Cost Analysis

  9. HSA/HDHP Wealth Accumulation

  10. Our Recommendations • HSA – Healthy family who only anticipates routine health needs • PPO – Health care needs which requires specialists • HSA/HDHP – Single and healthy

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