What is Indianapolis Health Insurance?

Indianapolis health care insurance protects individuals against loss by sickness or bodily injury. This is done with an insurance company covering the cost of health care.

To understand what Indianapolis health insurance is, you first need to have a basic understanding of insurance itself. How it works is basically there are two parties, the insured and the insurer. The two come to an agreement where the insurer pays a monthly or yearly fee and is covered for various health services. In the event that the insured needs some of these services then the insurer will agree to pay the cost of the services. This all depends if it is covered under the contract that was signed between the two.

In today’s society health care is constantly on the increase, that is why it is very important to make sure that individuals have some  form of Indianapolis health insurance. The cost of physician’s visits, medicine and preventive care or post care is sky high. Without the health insurance the cost of these vital health services would be really expensive, that is why it is good to have some form of coverage to offset the cost.

Indianapolis Health Insurance Information

To understand Indianapolis health insurance you need to know about the different types that are available. There are two main insurance types that is available to policy holders in Indianapolis, Indiana. These two are Fee for Service and Managed Care coverage. These two coverage plans are different in their own rights, yet they offer similar services when it comes to health care claims. The two different policies cover services such as surgical, medical, hospital related expenses, prescriptions drugs and sometimes dental services.
We will now examine the two types of coverage, Fee for Service and Managed Care.

1. Fee for Service or Indemnity
   

Fee for service under Indianapolis health insurance is a plan that essentially allows the policy holder to make all the choices related to his health care on his own. This type of plan works with the policy holder paying for a needed health care service with the physician of their choice. Once that is completed then a claim is submitted to the insurance company. Depending on what is contained in Indianapolis health insurance policy, then it is reviewed and if they health service is covered then the insurance company reimburses the policy holder. This type of policy carries with it a high deductible or copay compared to Managed Care insurance plans.

Advantage – The benefits of this type of plan is the power is more in the policy hand. The policy holder will be able to choose the health care professional of their choice.

Disadvantage – under this plan the policy will pay a higher deductible or copay compared to managed care plans.

Health Maintenance Organizations (HMO)

The most common type of managed care plan is called a Health Maintenance Organization or HMO. An HMO is a managed care plan that provides a full range of health care services to its members. The HMO Members must typically receive all of their medical care from health care providers in the HMO network, which is coordinated by a primary care physician.

To offer prepaid health coverage the HMO will enter into contracts with various health care providers. This means the members will have access to physician and hospital services. Under the HMO this is called a provider network.

Members of the HMO can only receive medical services from within the provider network. If they do go outside of the HMOs network they will not get any benefits or will not be covered. This essentially means that members are tied to the HMOs network.

 In an HMO the members will choose a Primary care Physician (PCP).  This physician is often times called a gatekeeper and he is responsible for all medical care for the member. The PCP will coordinate all aspects of the medical care. If the member needs to see a specialist outside of the network, then it has to be authorized by the PCP.

HMOs are a very restrictive managed health care plan. The members are tied to the private network when it comes to choosing their health services. The benefits under Indianapolis health insurance are greater and the costs are always lower than other managed care plans.

Preferred Provider Organizations (PPO)

Preferred Provider Organizations (PPO) Plans are another type of managed health care plan that exists under Indianapolis health insurance. The PPO operates where the insurer contacts with a specific number of physicians and hospitals to provide health care at different levels of reimbursement for each service offered. The preferred providers are often subject to other stipulations regarding the monitoring of utilization, the appropriateness of care provided, and the terms of the provision of care allowed under the arrangements.

In the PPO you are not required to have a private care physician (PCP) like an HMO. This also means you do not need to get referrals to get medical services outside of the private network. This is an added benefit for members as they are not stuck with the doctors and other health professionals, services that are offered in the private network. The PPO does have different incentives to make members use their private network. This means that they offer discounts on various types of payments that are usually associated with the plan. The disadvantage for going out of network is rise in the cost and payments.

Point of Service (POS)

A managed care plan that allows subscribers to choose providers or specialists within the plan’s network as referred by their primary care physician, or to self-refer to a provider outside the network. To receive the highest level of benefits, subscribers must use participating providers. Out-of-network services are allowed; however, benefits are paid at a reduced level.

Point of Service (POS) is a specific managed care plan. It operates on the same basis as an HMO or PPO. You still have to choose your physician or specialists from the selected network if you have any health related services that are needed.

In the PPO the individual chooses a primary care physician (PCP), even though this is not required. The PCP acts as the gatekeeper as with the HMO. Members do not have to use their PCP if they are looking for referrals. Referrals outside the network may be made, but you are responsible for filling out the necessary paperwork in order to get reimbursement for medical costs.

If you do opt to receive services from non-participating providers, then the benefit level will change. This means that if the patient chooses a non-participating provider then the cost, such as copays, coinsurance and deductibles will be considerably higher.

In Indianapolis, Indiana the POS is becoming the more popular health care plan choice. This is the due to the flexibility that the individual has as opposed to the HMO.