Everyone needs Insurance

When you enroll in a POS plan, you are required to choose a primary care physician to monitor your health care. This primary care physician must be chosen from within the health care network, and becomes your "point of service".

The primary POS physician may then make referrals outside the network, but then only some compensation will be offered by your health insurance company.

If the plan member chooses to obtain services from a provider outside of the  networks, the services will be reimbursed according to out-of-network rules (i.e., usually a co-payment and higher coinsurance charge will be required). Because people who belong to POS plans are responsible for deciding where to seek care, it is important that they understand the financial implications of these choices.

Preferred Provider Organization (PPO) - A PPO is a form of managed care closest to an indemnity plan, or traditional insurance plan. A PPO negotiates arrangements with doctors, hospitals, and other providers of care who accept lower fees from the insurer for their services. As a result, your cost sharing will be lower than if you go outside the network of providers.

If you go to a doctor within the PPO network, you will pay a co-payment (a set amount you pay for certain services - say $10 for a doctor or $5 for a prescription). In addition your coinsurance will be based on the lower charges for PPO members. For example, the insurer may reimburse you for 90% of the cost if you go to a provider within the network. If you choose to go to a provider out of the network, the insurer might only reimburse you for, say 70% of the cost. In addition, with an out-of-network provider, you may have to pay the difference between what the provider charges and what the plan will pay.

Another characteristic for PPOs is the ability to make self-referrals. In essence, plan members can refer themselves to doctors of their choice, including specialists inside and outside the network. However, as described above, plan members may incur additional charges for using out-of-network providers.

Corporate Benefit Plans helps companies in designing, selecting, implementing and administering these types of plans.

Self-Insured Plans - A plan offered by employers who directly assume the major cost of health insurance for their employees. Some self-insured plans bear the entire risk. Other self-insured employers insure against large claims by purchasing stop-loss coverage.

Some self-insured employers contract with insurance carriers or third party administrators for claims processing and other administrative services; other self-insured plans are self administered.

In many employee benefit plans, the use of self-insurance or partial self-insurance makes sense. Total self-insurance, or even partial self-insurance, is not seen frequently in group life, accidental death and dismemberment, long-term disability, long-term care, and specific disease policies. It is, however, seen frequently in group medical, dental, vision care, and short-term disability benefits.

When the term self-insurance is used, it may be referring to those plans which are only partially self-insured. Seldom does one find an employer that provides medical benefits and does not have some level of stop-loss insurance. It is not unusual to see dental, vision care, and short-term disability plans that are totally self-funded. The nature of these coverage's does not require stop-loss insurance for these benefits.

The use of self-insurance does not imply self-administration. The outsourcing of administration of all types of benefit plans makes sense as long as the costs for these services are reasonable. A properly administered plan generates cost-efficiency, as businesses which specialize in the administration of specific coverage's can be very effective in the management of claim costs.

Advantages of Self-Insurance: