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Private Individual and Family Insurance

Individual Insurance is a health policy that you can purchase for just yourself or for your family. Individual policies are also called personal health plans. If you’d like, you can work with an insurance agent to help you go over different plans and costs. You can choose the insurance company, the plan, and the options that suit your needs. You can renew, options and health insurance companies during the annual Open Enrollment period. Your plan is not tied to your job, so you can change jobs without losing your coverage. You can choose a plan that includes the doctors and hospitals you trust!

Health Maintenance Organization (HMO) Plans

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HMO Plans

HMO means “Health Maintenance Organization.” HMO plans offer a wide range of healthcare services through a network of providers who agree to supply services to members. With an HMO you’ll likely have coverage for a broader range of preventive healthcare services than you would through another type of plan.

Point-of-Service (POS) Plans

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POS Plans

POS plans combine elements of both HMO and PPO plans. Like an HMO plan, you may be required to designate a primary care physician who will then make referrals to network specialists when needed. Depending upon the plan, services rendered by your PCP are typically not subject to a deductible and preventive care benefits are usually included. Like a PPO plan, you may receive care from non-network providers but with greater out-of-pocket costs. You may also be responsible for co-payments, coinsurance and an annual deductible.

Prefered Provider Organization (PPO) Plans

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PPO Plans

PPO plans, or “Preferred Provider Organization” plans, are one of the most popular types of plans in the Individual and Family market. PPO plans allow you to visit whatever in-network physician or healthcare provider you wish without first requiring a referral from a primary care physician.

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In Network vs Out Network

“In-network” health care providers have contracted with your insurance company to accept certain negotiated (i.e., discounted) rates. You’re correct that you will typically pay less with an in-network provider. “Out-of-network” providers have not agreed to the discounted rates. Say you go to a doctor that’s in-network and the total charge is $250. A discount is applied to that amount for our negotiated rate with the doctor. The discount is $75. Blue Cross Blue Shield of Michigan pays $140. You’ll have to pay the remainder, which is $35. Now let’s say you go to a doctor that’s out-of-network. No discount is applied to the total charge. We still pay $140 but you’ll be responsible for the remainder, which is $110.

It’s often up to you to determine whether a given physician is in-network for your insurance plan, so make sure you ask the right questions. Keep in mind that accepting your insurance and being “in-network” are not necessarily the same thing. A physician may accept Humana, BlueCross BlueShield, UnitedHealth Care, Kaiser, etc. insurance, but that does not mean that he or she is an in-network provider for your plan with one of those insurance carriers. The best way to check is to call the customer service number located on your insurance card and verify a provider’s network status.

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