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Group medical insurance is a policy provided by employers to their employees and often their dependents. It covers a group of people under a single master policy, spreading the risk among the members. Group insurance plans are generally more affordable and offer broader coverage compared to individual plans. This is because the risk is spread over a larger pool of individuals, making it easier for insurers to manage costs.
ACA stands for the Affordable Care Act, also known as Obamacare. This law was enacted in the United States to reform the healthcare system and make health insurance more accessible and affordable. ACA-compliant medical insurance plans must meet certain requirements, including coverage for essential health benefits, preventive services without cost-sharing, and not discriminating against individuals with pre-existing conditions.
Minimum Essential Coverage (MEC) plans refer to health insurance plans that meet the minimum requirements set by the Affordable Care Act (ACA) to avoid penalties for not having insurance. These plans provide basic coverage for essential health benefits and preventive services.
Self-funded, or self-insured, plans are employer-sponsored health plans where the employer assumes the financial risk for providing healthcare benefits to employees. Instead of paying fixed premiums to an insurance company, the employer pays for the employees' medical claims directly. To manage potential large claims, the employer may purchase stop-loss insurance to limit their liability.
Reference based pricing plans are a type of health insurance arrangement where the insurer or employer sets a limit or reference point on how much they will pay for certain medical procedures or services. If the cost exceeds this reference price, the patient may have to pay the difference out of pocket.
A. Health Maintenance Organization (HMO): HMO plans require members to select a primary care physician (PCP) and get referrals from the PCP to see specialists. The network of healthcare providers is usually more limited, but the costs are generally lower.
B. Preferred Provider Organization (PPO): PPO plans offer more flexibility in choosing healthcare providers. Members can see any doctor or specialist without requiring referrals, but they get better rates and coverage when using in-network providers.
C. Exclusive Provider Organization (EPO): EPO plans are similar to PPO plans, but they do not cover out-of-network care except in emergencies.
D. Point of Service (POS): POS plans combine features of HMO and PPO plans. Members choose a primary care physician and need referrals to see specialists, similar to an HMO. However, they have the option to go out-of-network, though with higher out-of-pocket costs.
Traditional Quote form Fillable 4 fillable (pdf)
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