What is the difference between Georgia indvidual Open Access HMO health insurance and other types of Georgia individual health insurance plans?

Before we begin to try to understand the different types of Georgia health insurance, there is a bit of information we need to be familiar with. All insurance plans have certain things in common. It would be helpful to understand what they are so you can see how they apply to each type of insurance.

Deductible-This is the portion of any health charges that you pay before the insurance company pays anything (many plans waive the deductible for physician office visits, instead using an office visit co-pay). ALL plans have a deductible. It may be vary form $0 to $10,000, but it's always included in the plan benefits.

Coinsurance- After the deductible is met, you enter into a period of coinsurance. It's just what the name says. Two entities are paying the health costs during the coinsurance period. When you see the term 80/60 it means that if you stay in network, you pay 20% and the insurance company pays 80% of the charges. Out of network, you pay 40% and the insurance company pays 60%. There is normally a stop loss of $1000 or more that the insured has to pay. In other words, if your plan reads 80/20 through $5000, you would be responsible for 20% of $5000 after the deductible has been met. Then the insured's liability would stop and the insurance company would pay the rest.

Not all plans have coinsurance. Often, you won't find coinsurance in an HMO plan, and often it won't be in an H S A eligible plan.

After the deductible and coinsurance have been met, the insurance company has the liability of any other covered health charges during the plan year.

There is one more term you should be familiar with and that is the network.

NETWORK - A group of providers, doctors, hospitals, labs, etc. that have a relationship with the insurance company and have established specific pricing for services. This is the way that insurance companies manage their costs.

Now that you have a general definition of insurance terms, let's look at the different types of plans.

The term HMO stands for Health Maintenance Organization. Open Access HMO health insurance plans are designed to work in a similar manner to an HMO insurance plan with one exception. So, let's start by reviewing HMO plans.

An HMO is the broadest type of health coverage available. The deductible can be as low as $0 and many companies offer plans with no coinsurance.

Normally, an HMO has a co-pay for most services. The reason we say this is the most comprehensive coverage is that the co-pay covers most of the service that the physician or lab charges. When you go for an office visit, it's all-inclusive in most cases. Sometimes there is even a co-pay for a hospital stay or outpatient surgery. If you encounter coinsurance on an HMO, it usually will be in conjunction with a deductible for the hospital stay. HMO's usually fully cover the cost of physicals, where the other plans normally have a limit to what they will pay for a physical. A traditional HMO plan requires that the insured member get a referral before going to see a specialist with the exception of a Dermatologist, a Psychiatrist, and/or an OB/GYN specialist.

The big difference in an Open Access HMO health insurance plan is that the member is not required to get a referral to see a specialist, however, the specialist must be in the network in order for health insurance benefits to be paid.

Advantages-The HMO offers the broader coverage with less out of pocket costs during the plan year.
Disadvantages-Primarily less choice in doctors and hospitals. Sometimes doctors in an HMO will be employees of the HMO and not in private practice. Treatment is sometimes in a clinical environment in these cases.

Here are some of the other types of insurance plans that are available in Georgia:
HMO Individual and Group Health Insurance Plans
POS Individual and Group Health Insurance Plans
Open Access POS Individual and Group Health Insurance Plans
PPO Individual and Group Health Insurance Plans
H S A Individual and Group Health Insurance Plans
Indemnity Individual and Group Health Insurance Plans

We hope this information is helpful to you. If you would like further information or have questions, please feel free to contact us at Insurance Now and we will spend whatever time is needed to help you make sure that you select the right plan for you.

9 Dunwoody Park Suite 136 Atlanta, GA 30338	Call Holly, Chris or Bob at (770) 396-9517 Outside of the Atlanta area, call toll-free: 1-877-711-8376. fax: 770-396-4318 Email: holly@insurance-now.com