Traditional insurance plans, commonly known as indemnity and “fee-for-service plans,” require insurance companies to pay a set portion of your total medical charges while the plan holder pays the other part of a pre-determined percentage of medical charges. These plans typically work along a ratio scale where providers define how much you and your insurance must each pay.
For example, a particular traditional insurance plan may require that the plan holder pay 20 percent of their total medical charges and will bill their insurance for the remaining 80 percent of their medical charges. These numbers can be inverse or require both parties to split the owed charges 50/50. Numbers vary across numerous plans – it all depends on what insurance plan you choose.
Traditional plans require that plan holders pay an annual deductible before the insurance company begins to pay their portion of medical claims and charges. Once your plan’s deductible has been fulfilled, the insurance company will pay your claims at a set percentage of the “usual, customary and reasonable (UCR) rate” for the services rendered. The UCR rate is the total amount that health care providers in your area or region typically charge for any provided medical service.
Los beneficios de los planes de seguros tradicionales
Los planes tradicionales se diferencian de las Organizaciones para el Mantenimiento de la Salud (HMO) y las Organizaciones de Proveedores Preferidos (PPO) porque otorgan a los titulares del plan la capacidad de auto-remitirse a especialistas sin tener que obtener una remisión para recibir una compensación por elegir ver a un especialista.
It’s always best to contact your provider to learn the full scope of your plan’s benefits, rules and guidelines; however, the ever-changing health care market can be confusing to navigate on your own and can be difficult to keep up with, even for providers.
Permítanos ayudarle a eliminar el misterio y el dolor de cabeza que supone lidiar con los planes de seguro
If you’ve been searching for an insurance provider who takes an educational approach to helping you assess your individual or family benefits package and helps you stay current with the latest changes and options, contact Primary Care Insurance Solutions today! We’re proud to be a licensed general health insurance agent as it enables us to offer a wide variety of plans through a number of different carriers, which not only gives you more options, it also drives the prices down out of increased competition.
Nuestros profesionales, amables y expertos, repasarán con usted los beneficios, las normas y las pautas de su seguro y le aconsejarán sobre la mejor manera de proceder a la hora de decidir qué plan de seguro tradicional es el más adecuado para usted. Esperamos poder responder a todas sus preguntas y ser su socio en el cambiante mundo de la cobertura de seguros.
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