Because not all health insurance plans are the same and not all health insurance companies are the same, it is crucial to understand the different types of health plans that exist so that you can take the right decision.
In this article, we’ll take a look at the type of health plan and, most importantly, how to decide which one is right for you.
The most common type of health insurance plan
I don’t know what types of health insurance in Nigeria are the best for you? The following is a general description of each of the types of health plans.
1. PPO (Preferred Supplier Organization or Participant)
This type of health insurance plan is a health care agreement that offers a discount to policyholders or insureds for the services they receive from specific health care providers. This scheme encourages policyholders to use a specific network of health professionals and privileged hospitals. When using a PPO insurance plan and looking for services under your specific network arrangement, you have to incur higher costs.
In a PPO insurance agreement, healthcare professionals contract with insurance providers or companies to provide healthcare services to agreed participants at a reduced price in exchange for paying a small fee. Thus, the insured are free to use the services of any health professional in this network, but care outside the network will cost more.
PPO offers many advantages such as greater flexibility than some other insurance plans, substantial discounts, a large network of professionals to choose from, which in turn provides greater value to policyholders. Participants in a PPO agreement are permitted to visit any physician or hospital without a referral from their primary care physician.
2. HMO (health maintenance organizations)
HMO is a type of health insurance plan or coverage that provides medical care through a network of doctors and other health care providers who are contracted with HMOs for a monthly or annual fee.
Typically, you should have a primary care physician in your HMO network who coordinates your care. This plan encourages policyholders to use a specific network of healthcare professionals and hospitals. However, unlike a PPO, restrictions are placed on HMO policyholders as they cannot seek out-of-network care as the HMO will not pay for them except in certain emergency cases or when the HMO has no influence. – network provider for the health service you need. In the same vein, to consult a specialist within the framework of an HMO, a referral from a primary care physician is necessary.
One of the advantages of HMOs is that it is a more economical choice, as HMO providers are paid per member, regardless of the number of times they see a member. You also have the option of having a primary health care physician who manages your care under an HMO agreement.
You do not know where to start ? Discover RelianceHMO, Nigeria’s leading health insurance company.
3. POS (point of service)
It is a kind of managed health insurance that offers values ââand earnings depending on whether you use networked or off-network medical services. They are a hybrid of health maintenance organizations (HMOs) and preferred supplier organizations (PPOs).
POS integrates the elements of the HMO and PPO plans. For a point of sale, you must choose a primary care doctor and you always need the referral from your primary care doctor before you can see a specialist; just like HMO. However, the point of sale provides coverage for off-grid services, although it will cost more, as in the case of PPO, unless your primary health care provider has referred it to the off-grid provider.
POS is beneficial because it combines the best features of HMOs and PPOs. The health care services of POS plans often cost less than other policies. Another added benefit is the flexibility of coverage offered by the point of sale. It really is an affordable plan with off-grid coverage.
4. EPO (exclusive supplier organizations)
This is a type of managed health insurance where you need to get your health care exclusively from healthcare professionals or hospitals your EPO has contracted with, otherwise your EPO will not pay, except by emergency. This health care network is similar to HMOs. However, EPO networks are generally larger than HMOs.
When using EPO, you do not necessarily need a primary health care doctor, although it is always advisable to have one. EPOs also do not require referrals before they can see a specialist.
EPO plans are generally more affordable than PPO plans. They also have lower rates than some other types of plans. Another advantage of EPOs is the ability to see a specialist without a referral.
It is a comprehensive form of insurance plan. Some have argued that this is not an insurance plan in the true sense of the word. Compensation plans are also referred to as fee-for-service health insurance plans or traditional compensation plans. It is an insurance policy in which the insurance company pays a predetermined percentage of the costs for given health services, while the insured pays the remainder of the costs.
The allowance allows you to run your own healthcare and visit any healthcare professional or hospital you choose, with the insurance company paying a set portion of your total costs. Under this plan, there is no supplier network. You have the freedom to choose. Your insurance company won’t force you to choose a primary care doctor, and you don’t need any referrals before you can see a specialist.
The great level of freedom offered by compensation health insurance plans makes it advantageous as you would want to see any doctor you want. It also offers greater flexibility and a wide range of protective coverages in a health insurance plan.
What type of health insurance is right for me?
Although you have familiarized yourself with the different types of health insurance that are out there, you might be confused about which health insurance choice to make.
There is no one size fits all. Each type of insurance has its own characteristics, advantages and limitations.
Your choice of health insurance will depend on many factors such as:
- The flexibility of health insurance
- The total cost of health care
- Types of plans and networks,
- Quality of health care you are looking for.
- Your specific health needs and risks.
- Type of coverage either by the company, or by yourself or by the government?
For some it may be the final exit of premiums, while for others it may be the health coverage offered by a plan.
Ask questions to your employers or your mutualYes, in order to help you define the best health care insurance for your particular needs and costs, will be a good place to start.
Health insurance can play the role of keeping you healthy with preventative medications such as check-ups; because prevention, they say, is better than cure.
It can also help manage pre-existing conditions like diabetes and disabilities because most health insurers offer management programs for these types of conditions.
Do you always wait to be insured?
Life is unpredictable, protect it with health insurance.
* This is a featured article.