> Preferred Provider Organization (PPO) PPOs are comparable to indemnity plans, although they require subscribers to choose their health-care providers and health-care facilities from a preferred-provider list. Because the preferred providers have agreed to the plan's requirements, including discounted fees, subscribers have a financial incentive to stay within the network.
> Indemnity Indemnity plans are also referred to as “fee-for-service.” Unlike managed-care plans, indemnity plans allow absolute freedom in selecting physicians or medical facilities and permit self-referral to a specialist.
> Health Maintenance Organization (HMO) Managed-care insurers — known generally as HMOs — use a primary care physician as a gatekeeper to screen patients and see that appropriate treatment takes place at the lowest level possible. In order to see a specialist or receive specialized care, patients must see the gatekeeper physician first and be referred on.
HIPAA offers protections for individuals who have preexisting conditions, helping them to keep coverage for those conditions or get coverage in no more than 12 or 18 months through limits on preexisting condition exclusions.
HIPAA includes protections to help ensure individuals are not excluded from coverage under their group health plan or charged a higher premium based on health status.
COBRA generally requires that group health plans of employers with at least 20 employees offer employees and their dependents the opportunity to continue their health plan coverage for limited periods of time when the employee loses his or her job due to retirement.
ERISA Claims Procedures help ensure fair and timely appeals process for covered individuals.
ERISA Disclosure Provisions require that group health plan disclosure material furnished to plan participants and beneficiaries must contain information about specialists in the plan network and the plan’s rules for accessing specialty care.
ERISA Disclosure Provisions also require that plan disclosure material must describe the ability of the employer to reduce plan benefits or terminate the plan.
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Did You Know?
Payments you receive from qualified long-term care insurance contracts will generally be excluded from income
As reimbursement of medical expenses received for personal injury or sickness under an accident and health insurance contract. Also, certain payments received under a life insurance contract on the life of a terminally or chronically ill individual (accelerated death benefits) can be excluded from income. Refer to Publication 17, Your Federal Income Tax, Chapter 13, Other Income.
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Jan 18, 2006 - Progressive Group, Drive Insurance Company NEW YORK (January 12, 2006) — Drive® Insurance from Progressive ("Drive") Group President Bob Williams ra Read more >
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