Health

Types of Insurance Plans

Major Medical (Traditional Health Plans)

A policy designed to reimburse the insured for excess medical expenses in and out of the hospital. The policy usually includes a deductible, a coinsurance clause and an aggregate limit.

Managed Care Plans (HMOs and PPOs)

Health Maintenance Organizations (HMOs)

An entity with four essential characteristics an organized system for providing health care in a geographical area delivering an agreed upon set of basic and supplemental health maintenance and treatment services mental health maintenance and treatment services to a voluntarily enrolled group of persons for which services the HMO is reimbursed through a predetermined and periodic prepayment made by or on behalf of each person or family unit enrolled in the HMO, without regard to the amounts of actual services provided.

Preferred Provider Organizations (PPOs)

A group of health care providers, each of whom agrees to offer services to a given employer or insurer at a lower cost in return for a stable volume of patients or other incentive(s)

Group (Contact employer to determine your status)

Insured

Group inurance programs designed to offer affordable health coverage to a natural group, such as employees of an employer or members of an association and their families. A single contract is provided for the entire group which outlines the standard benefits, terms and provisions that apply to all members of the group Individual certificates are usually issued to the members to verify that they are covered.

ERISA

When an employer decides to fund and administer his/her own employee benefit plans they are regulated by the U.S. Government by means of the Employees Retirment Income Security Act (ERISA) of 1974.

Dental

A type of health insurance sold on an individual or group basis that will provide benefits for care and treatment of the teeth and gums. Benefits vary from policy to policy as some may cover 100% of the preventative care (such as semi-annual check-ups, fluoride treatments, etc.) while others may only cover a portion of the preventative care. There is normally an annual benefit maximum for preventative care services. However, benefits for orthodontic procedures (e.g. braces, retainers, etc.) are normally extremely limited and have a lifetime benefit maximum.