Today's
health
insurance
market
is
broken
into
many
segments.
Some
are
highly
specialized
in
their
coverage
and
others
are
more
comprehensive.
The
more
comprehensive
and
inclusive
the
health
insurance
the
higher
the
premiums.
It
is
generally
in
your
best
interest
to
purchase
group
coverage
(through
an
employer)
when
available.
Group
coverage
is
generally
more
comprehensive
and
group
rates
are
generally
lower
because
their
is
strength
in
numbers.
However,
group
plans
are
almost
always
managed
care
programs
and
have
lots
of
restrictions.
If
group
coverage
is
not
available
then
you
will
have
to
purchase
an
individual
plan.
Individual
plans
are
medically
underwritten
and
there
are
no
guarantees
that
an
insurer
will
approve
your
application.
Premiums
for
individual
policy
holders
are
more
in
line
with
their
expected
health
care
cost
than
in
group
coverage.
That
means,
the
premiums
will
be
higher
for
those
who
are
older
or
less
healthy.
Health
Insurance
"Short-Term"
As
its
name
implies,
short-term
health
insurance
is
temporary
coverage
and
lasts
from
one
to
six
months.
Some
companies
may
allow
the
insured
to
renew
the
policy
one
time
but
the
total
length
of
coverage
will
not
exceed
twelve
months.
This
is
perfect
for
someone
who
just
dropped
off
their
parents'
policy
because
they
graduated
from
college
or
maybe
they
hit
that
age
limit
and
need
health
insurance
before
they
find
a
full-time
job.
Or
maybe
for
somebody
between
jobs.
Coverage
is
generally
comparable
to
that
of
an
HMO
or
similar
plan
and
typically
includes
various
hospital
charges,
office
visits,
diagnostic
tests,
and
prescription
drugs.
Maternity
costs
are
not
covered,
however.
Unlike
an
HMO
or
PPO,
though,
a
short-term
plan
is
an
indemnity
plan,
which
means
you
have
the
freedom
to
go
to
any
doctor;
you're
not
confined
to
a
network
of
doctors.
Plans
are
typically
offered
with
a
number
of
deductibles
ranging
from
$200
to
$2,000.
Most
young
adults
choose
the
$500
deductible
or
the
$250
deductible.
Older
adults
generally
choose
higher
deductibles
to
offset
their
higher
premiums.
The
down
side
of
short-term
policies
In
many
short-term
policies
the
deductible
you
pay
is
per
injury
or
illness.
That
means
you
must
meet
the
deductible
all
over
again
each
time
you
are
treated
for
a
ear
infection
or
other
illness.
After
you
meet
the
deductible,
the
company
pays
80
percent
of
the
next
$5,000
in
expenses
and
then
pays
100
percent.
Short-term
policies
also
have
certain
strict
eligibility
requirements,
although
they
will
vary
from
insurer
to
insurer.
If
you
have
ever
been
denied
health
insurance,
you
won't
be
eligible
for
short-term
insurance
because
a
denial
indicates
you
might
have
significant
health
problems.
In
addition,
if
you
have
a
pre-existing
condition
(an
illness
or
chronic
condition
you've
had
within
the
previous
five
years),
it
won't
be
covered
under
most
short-term
plans.
That
means
if
you've
had
leukemia,
a
stroke,
or
even
allergies
or
asthma
within
the
last
five
years,
those
illnesses
won't
be
covered
under
your
short-term
policy.
Pregnancy
is
not't
covered
either,
although
complications
arising
from
pregnancy
generally
are.
And
what
happens
if
you
bought
a
three-month
policy
only
to
find
that
the
job
you
hoped
to
land
-
with
health
benefits
-
has
not't
materialized?
Don't
count
on
automatically
being
able
to
renew
your
short-term
policy,
because
it
doesn't
work
that
way.
You
have
to
go
through
the
application
process
all
over
again
and
take
out
a
new
policy.
If
you
had
any
illnesses
or
injuries
during
your
previous
policy
period,
those
now
become
pre-existing
and
won't
be
eligible
for
coverage.
Shop
around
on
your
own
compare
rates
and
benefits
from
several
companies
to
make
sure
you
get
a
plan
that's
right
for
you.
For
more
information
and
rates
on
short-term
health
insurance
visit
our
specialist
site
below.
Self
funded
or
Partially
Self
Funded
Health
Insurance
Partially
or
Fully
self
funded
health
insurance
policies
are
intended
only
to
pay
for
employee
expenses
from
general
funds
up
to
a
point
normally
called
a
deductible
(specific
deductible
per
claim
per
employee),
after
which
an
insurance
company
pays
100%
of
that
claim.
Also
,
the
insurer
will
pay
100%
of
claims
after
a
group
deductible
has
been
met
by
all
employee's
claims
totaled,
capping
the
employer
cost
in
any
year.
Employee
deductible......in
a
partially
self
funded
plan
the
claims
for
an
employee
are
paid
from
general
funds
of
the
employer
up
to
the
deductible
stated
(the
specific
deductible
per
employee),
and
operates
much
like
a
traditional
plan
with
the
deductible
being
the
deductible
per
employee
per
year.
After
that
deductible
an
insurance
company
pays
100%
of
the
claim.
Employer
deductible......
in
a
partially
self
funded
plan,
this
is
the
deductible
past
which
the
insurance
company
pays
100%
of
claims,
not
only
on
the
individual's
claims
but
on
all
claims
incurred
within
that
year.
The
Plan
pays
bills
incurred
by
employees
just
as
if
an
insurance
company
were
paying
from
dollar
one.
ADVANTAGES
In
good
claims
years
the
employer
gets
to
keep
the
otherwise
lost
premium
money,
and
thus
has
reduced
his
costs
for
that
employee
benefit
plan.
Another
Advantage
is
that
for
an
employer
in
multiple
states,
plans
benefits
are
uniform
for
all
employees.
Another
Advantage
is
that
the
employer
can
dictate
,
within
guidelines,
what
benefits
will
be
made
available
to
employees.
Another
Advantage
is
that
the
employer
does
not
pay
premium
taxes
on
the
saved
premium
dollars.
Self
Funded
health
insurance
policies
typically
come
with
a
very
high
deductible
from
$20,000
to
$65,000.
Who
buys
self
funded
health
insurance?
Generally
employers
of
100
people
or
greater.
70%
of
all
companies
with
200+
employees
are
self
or
partially
self
funded
for
insurance
purposes.
Is
Self
Funded
Coverage
Right
For
You?
As
with
all
insurance
you
are
gambling.
With
self
funded
coverage
you
are
elimining
coverage
to
reduce
premiums.
Be
careful
not
to
take
a
deductible
larger
than
you
can
afford
and
plan
for
what
you're
comfortable
with
is
the
worst
happens.
Shop
around
on
your
own
or
talk
to
an
independent
insurance
agent
to
make
sure
you
get
a
plan
that's
right
for
you.
For
more
information
and
rates
on
self
funded
health
insurance
visit
www.grouphealthplans.com
or
call
1
888
456
1858
/
504
456
1858.
Traditional
Health
Insurance
Up
until
about
30
years
ago,
most
people
had
traditional
indemnity
coverage.
These
days,
it's
often
known
as
fee-for-service.
Indemnity
plans
are
a
bit
like
auto
insurance:
you
pay
a
certain
amount
of
your
medical
expenses
up
front
in
the
form
of
a
deductible
and
afterward
the
insurance
company
pays
the
majority
of
the
bill.
Advances
in
modern
medicine
increased
the
cost
of
providing
health
care
and
made
it
possible
for
people
to
live
longer.
Those
advances
caused
many
insurance
companies
to
look
for
ways
to
reduce
their
costs
of
doing
business,
giving
managed
care
the
boost
it
enjoys
today.
Fee-For-Service
For
years,
indemnity
or
fee-for-service
coverage
was
the
norm.
Under
this
type
of
health
coverage,
you
have
complete
autonomy
when
it
comes
to
choosing
doctors,
hospitals
and
other
health
care
providers.
You
can
refer
yourself
to
any
specialist
without
getting
permission,
and
the
insurance
company
doesn't
get
to
decide
whether
the
visit
was
necessary.
You
don't,
however,
have
complete
autonomy.
Most
fee-for-service
medicine
is
managed
to
a
certain
extent.
For
instance,
if
you're
not
already
incapacitated,
you
may
need
to
get
clearance
for
a
visit
to
the
emergency
room.
On
the
down
side,
fee-for-service
plans
usually
involve
more
out-of-pocket
expenses.
Often
there
is
a
deductible,
usually
of
about
$200,
before
the
insurance
company
starts
paying.
Once
you've
paid
the
deductible,
the
insurer
will
kick
in
about
80
percent
of
any
doctor
bills.
You
may
have
to
pay
up
front
and
then
submit
the
bill
for
reimbursement,
or
your
provider
may
bill
your
insurer
directly.
Under
fee-for-service
plans,
insurers
will
usually
only
pay
for
reasonable
and
customary
medical
expenses,
taking
into
account
what
other
practitioners
in
the
area
charge
for
similar
services.
If
your
doctor
happens
to
charge
more
than
what
the
insurance
company
considers
reasonable
and
customary,
you'll
probably
have
to
make
up
the
difference
yourself.
Traditionally,
preventive
care
services
like
annual
check-ups
and
pelvic
exams
have
not't
been
covered
under
fee-for-service
plans.
But
as
the
evidence
mounts
that
preventive
care
can
prevent
more
costly
illnesses
down
the
road,
some
insurers
are
including
them.
Fee-for-service
plans
often
include
a
ceiling
for
out-of-pocket
expenses,
after
which
the
insurance
company
will
pay
100
percent
of
any
costs.
Traditional
fee-for-service
coverage
offers
flexibility
in
exchange
for
higher
out-of-pocket
expenses
and
is
not
for
everyone.
Shop
around
on
your
own
or
talk
to
an
independent
insurance
agent
to
make
sure
you
get
a
plan
that's
right
for
you.
For
more
information
and
rates
on
short-term
health
insurance
visit
our
specialist
site
below.
A
Preferred
Provider
Organizations
is
the
least
restrictive
type
of
managed
care.
PPOs
have
made
arrangements
for
lower
fees
with
a
network
of
health
care
providers.
PPOs
give
their
policyholders
a
financial
incentive
to
stay
within
that
network.
For
example,
a
visit
to
an
in-network
doctor
might
mean
you'd
have
a
$10
co-pay.
If
you
wanted
see
an
out-of-network
doctor,
you'd
have
to
pay
the
entire
bill
up
front
and
then
submit
the
bill
to
your
insurance
company
for
an
80
percent
reimbursement.
In
addition,
you
might
have
to
pay
a
deductible
if
you
choose
to
go
outside
the
network,
or
pay
the
difference
between
what
the
in-network
and
out-of-network
doctors
charge.
With
a
PPO,
you
can
refer
yourself
to
a
specialist
without
getting
approval
and,
as
long
as
it's
an
in-network
provider,
enjoy
the
same
co-pay.
Staying
within
the
network
means
less
money
coming
out
of
your
pocket
and
less
paper
work.
Preventive
care
services
may
not
be
covered
under
a
PPO.
Exclusive
Provider
Organizations
are
PPOs
that
look
like
HMOs.
EPOs
raise
the
financial
stakes
for
staying
in
the
network.
If
you
choose
a
provider
outside
the
network,
you're
responsible
for
the
entire
cost
of
the
visit.
Is
a
PPO
Right
For
You?
Rates
and
coverage
vary
form
state
to
state
so
shop
around
on
your
own
or
talk
to
an
independent
insurance
agent
to
make
sure
you
get
a
plan
that's
right
for
you.
For
more
information
and
rates
on
PPO
health
insurance
visit
our
specialist
site
below.
Point-of-Service
(POS)
"Managed
Care"
A
Point-of-Service
plan
is
a
little
more
least
restrictive
type
of
managed
care.
Point-of
Service
plans
like
PPO's
have
made
arrangements
for
lower
fees
with
a
network
of
health
care
providers
and
give
their
policyholders
a
financial
incentive
to
stay
within
that
network.
However,
Point-of-service
plans
introduce
the
gatekeeper,
or
Primary
Care
Physician.
You'll
need
to
choose
your
primary
care
physician
(PCP)
from
among
the
plan's
network
of
doctors.
As
with
the
PPO,
you
can
choose
to
go
out
of
network
and
still
get
some
kind
of
coverage.
In
order
to
get
a
referral
to
a
specialist,
though,
you
usually
must
go
through
your
PCP.
You
can
still
choose
to
refer
yourself,
but
it'll
mean
more
hassles
and
more
money
coming
out
of
your
pocket.
If
your
PCP
refers
you
to
a
doctor
who
is
out
of
the
network,
the
plan
should
pick
up
most
of
the
cost.
But
if
you
refer
yourself
out,
then
you'll
probably
have
to
deal
with
more
paper
work
and
a
smaller
reimbursement.
You
may
also
have
to
pay
a
deductible
if
you
go
outside
the
network.
POS
plans
may
also
cover
more
preventive
care
services,
and
may
even
offer
health
improvement
programs
like
workshops
on
nutrition
and
smoking
cessation,
and
discounts
at
health
clubs.
Is
a
POS
Right
For
You?
Rates
and
coverage
vary
form
state
to
state
so
shop
around
on
your
own
or
talk
to
an
independent
insurance
agent
to
make
sure
you
get
a
plan
that's
right
for
you.
For
more
information
and
rates
on
POS
health
insurance
visit
our
specialist
site
below.
