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At HealthCompare, we get asked questions about Health Plans everyday. We know the questions you are asking and know the answers. We have taken this knowledge and created some slide presentations. This one is on Managed Health Plans. Enjoy
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What are Managed Care Plans?Managed Care Plans consist of a network of doctors and hospitals, or “providers.” You must choose among the providers in their network.
You can only receive the benefits of the discounts negotiated with specific doctor, hospitals, and health care providers in their network.
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HMOs: Health Maintenance Organizations
PPOs: Preferred Provider Organizations
POS: Point of Service Plans
We’ll focus on the first two…
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HMO (Health Maintenance Organization) Insurance company determines care
provider May be limited with coverage area or
available doctors Limited number of specialists Typically limited care options
PPO (Preferred Provider Organization) You determine care provider Typically national coverage Options for any specialist Options for best available care
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HMO
P
O
P
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They often require you to see a provider within the network and to obtain referrals from a primary care physician.
These restrictions help to control costs.
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If you decide that an HMO is the right plan for you, don’t forget to keep asking questions.
HealthCompare helps you to compare similar plans to find the perfect one for you.
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Questions to compare plans: How do I determine which doctors are accepting
new patients? Can I change doctors? How are referrals handled if I need care from a
specialist? How is emergency care handled? What services are covered, including preventive
care? What if I need services not provided by the HMO
network? Are there additional fees or co-payments required
for office visits, emergency care or other services and, if so, how much are they?
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Preferred Provider Organizations (PPO) are a form of managed care plan. PPO does not necessarily require
that you choose a primary care physician to supervise and make decisions for your health care.
In addition, with a PPO, you may be able to access providers and services outside of the “preferred” provider network.
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It is important to note that PPO plans will likely involve more out of pocket costs than an HMO. PPOs typically involve deductibles, co-payments,
and coinsurance amounts. The increased financial responsibility with a PPO is
a trade-off for the higher level or flexibility that you have in choosing a provider and accessing care.
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What services are covered? What are the deductible, co-pay and coinsurance amounts?What is the out-of-pocket maximum. What are the coinsurance amounts for non-preferred or out of network providers? Are there per-visit fees or other types of co-pays for in-network services? What is the cost difference between using in-network and out-of-network doctors, and what costs are associated with care outside of the PPO?
Who is HealthCompare: HealthCompare is your online one-stop-shop for health insurance
where you can research and compare plans online from over 150 national carriers.
We Promise: To give you the best results for YOU, we never promote one carrier
over the other. We just assess your needs and show you the best options from national carriers with plans in your area.
Our Commitment is to YOU: As a division of The Word & Brown Company who has been the
leading source for small group health insurance for over 20 years, we have leveraged technology to build an easy-to-use research tool, supported by a world class customer service team.
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OurPromise
#1
3. You can even compare
plans side-by-side
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4. Then, you can apply online or call one of our
trained Benefits Advisors for help!
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Call toll free 877-641-1101
to speak to a trained Benefits Advisor
or…Go to HealthCompare.org today!
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