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affordable individual health insurance
Years ago, acquiring your first health coverage was almost a right of passage. You began your career and you were automatically enrolled in your employers health plan after your first 90 days of employment. That still takes place today but the health care industry has metamorphosed into a gigantic monster gobbling up resources everywhere it travels. Rates keep going up at an astounding pace and more employers are cutting back on their plans or doing away with their health benefit packages entirely.
To help prevent adverse selection, insurance companies are allowed to look back at your medical history for pre-existing conditions and may choose not to cover certain conditions for a specified period of time. This is known as an exclusionary, or pre-existing condition, waiting period. The amount of time an insurance company can look back at your medical history, and the length of time an exclusionary period can last, vary on a state-by-state basis. NAHU's Health Care Coverage Options Database will tell you what the requirements are in your state.
HMOs most often have this type of system wherein a primary care physician must be selected who in turn will authorize all care for a member including referrals to specialists.
Staff model – This arrangement is pretty self-explanatory wherein the physicians are paid employees working on the staff of an HMO in a clinical setting at the HMO physical facilities. The HMO often owns the hospital as well. In this model the HMO is taking all the financial risk as opposed to the group model.
Once the company has determined your health status, you will be assigned a rate class by the company and put into a pool of other insured individuals with similar health status. Your premium will be the rate charged to that entire class of customers. Subsequent annual renewal premium rates will be determined not by your individual claims, but instead by the claims experience of the entire rating class pool.
The organizers and providers agree upon medical service charges that are generally less than the provider would charge patients not associated with the PPO. These differ from HMOs in that the providers are paid on a fee for service basis rather than receiving a flat monthly amount.
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