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health insurance quote virginia
Are lab fees and x-rays included? Can you choose your own physician or select from a list of providers? What is most important to you? Does the coverage include dental, vision, maternity, well-baby care, etc.
These are combined because the HMO is made up of medical practitioners who provide specific services to HMO members at prices that are pre-set and the HMO member agrees to pay the HMO a specified amount in advance to cover necessary services. Therefore, the HMO is furnishing health services as well as making the financial arrangements.
This type of coverage generally assumes that the medical provider (usually a doctor or hospital) will be paid a fee for each service rendered to the patient—you or a family member covered under your policy. With fee-for-service insurance, you go to the doctor of your choice and you or your doctor or hospital submits a claim to your insurance company for reimbursement. You will only receive reimbursement for "covered" medical expenses, the ones listed in your benefits summary.
If the employee fails to apply during that eligibility period, then the employee will be required to take a physical examination and must qualify as if on an individual basis. This is how an insurer can afford to cover a group of people without individual selection. Otherwise some people might choose not to enroll until they discover they have an illness or they become disabled, and requiring a physical exam after the eligibility period helps to preclude this event.
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.
Network model – This arrangement works like the Group model with the difference being that the HMO will contract with more than one group to provide the services. The primary purpose for this model is to provide convenience and increase accessibility for the members.
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