Knowing the details of your health plan will help you minimize costs.
There are many types of health plans, each with different advantages and disadvantages. Choosing the right health plan for you will depend on your needs, the needs of your family or the needs of your business. Knowing the details of the plan you choose will help you maximize your benefits and decrease out-of-pocket costs.
Health Insurance
In her textbook about insurance and billing, Marie Moisio defines health insurance as a "legal contract" between an individual (or group) and the insurance company. As long as the individuals pay their premiums, a fee paid to maintain the policy, the insurance company will "pay bills generated by illness."
HMOs and PPOs
The Health Maintenance Organization is a popular insurance plan. The insurance company enters into contracts with certain physicians, groups and hospitals. The physicians who take part in HMO contracts may also be involved in profit-sharing. This is sometimes an unpopular plan because doctors run the risk that their patients will believe they will refer them only to other physicians and facilities within the plan to increase their profit margins.
The Preferred Provider Organization is also common. The PPO choice also has a selection of physicians, groups and facilities from which to choose. Unlike the HMO, however, the physicians agree to be paid a discounted fee for the services they provide and they are not allowed to benefit from profit sharing.
BCBS of North Carolina
BlueCross BlueShield of North Carolina is one type of insurance plan. It provides a variety of options for health insurance plans. It has HMO options (like BlueCare and BlueMedicare HMO) as well as PPO options (BlueOptions and BlueMedicare PPO). It also has other plans like BlueOptions 1-2-3, a lower-cost plan with three levels of choice so enrollees can select the program that best fits their needs. The BCBSNC website boasts of its "comprehensive plans to our large provider network." According to the site information, its focus is on providing services to employers, regardless of size.
Aetna
Aetna's focus, according to website information, is on individual and family coverage. The company says its mission is to "get everyone covered." It, too, provides benefits for small, mid-sized and large businesses. While BCBSNC has plans directed at serving the Medicare population, Aetna's site offers "health care management services for Medicaid plans." It does not, however, exclude Medicare enrollees.
Cost
It is difficult to determine the cost of plans for both companies. Premiums will depend on what kind of coverage is necessary (individual, group) and what services are needed (hospitalization, eye, dental). Each website provides information on get a quote specific to your needs.
Tags: insurance company, North Carolina, health plan, health plan will, individual group
