NASE News

Sample Table Styles for Health 101

Group Health vs. Individual Coverage

When it comes to health insurance, it pays to be part of a group. Group premiums are cheaper because insurers spread the risk of claims over a greater number of people. Most group plans are offered as part of a comprehensive employee benefits package, but they can also be purchased through professional associations, trade unions, or churches.

Sold directly to you, individual insurance may be a good choice if you’re self-employed and can’t otherwise join an association, or you work for a company that doesn’t offer benefits.

 

 

Fee for Service (FFS)

Preferred Provider(PPO)

Point of Service (POS)

Health Maintenance Organization (HMO)

CONS

Usually a deductible (from $500 to $1500) before the insurer starts paying claims and then doctors are reimbursed about 80 percent of the bill while you pick up the remaining 20 percent.

You may have to pay up front from health care services and then submit the bill for reimbursement.

 Some FFS plans only pay for “reasonable and customary” medical expenses. If your doctor charges more than the average for your area, you will have to pay the difference.

If you visit an out-of-network provider, you may have to pay the entire bill yourself and then submit it for reimbursement.

You may have to pay a deductible if you choose to go outside the network, or pay the difference between what network doctors and out-of-network doctors charge.

You must select a Primary Care Physician (PCP).

If you do see a non-network provider without permission from your PCP, you’ll end up submitting the bills yourself and receiving only a small reimbursement – if any at all.

You must choose a Primary Care Physician (PCP).

HMOs require you to see only network physicians, or they won’t pay.

You must get a referral from your PCP to see a specialist.