Group Health Coverage

Health insurance coverage through an employer or other entity such as an association that covers all individuals in the group. This is considered to be an employee benefit. There are some state and federal mandates on what must be covered but there can be vast differences between one group health insurance policy and another.

 

Individual Coverage

Health insurance coverage on an individual basis. The premium is usually higher for individual health insurance than for group health coverage. These policies are generally health underwritten. That means, you must submit health information. The insurance company will use this to determine if the person is eligible and the premium (if the person is eligible).

 

Health Maintenance Organization (HMO)

Health Maintenance Organizations represent insurance plans in which individuals or their employers pay a fixed monthly fee for services instead of a separate charge for each visit or service. The monthly fees remain the same, regardless of types or levels of services provided. Services are provided by physicians who are employed by, or under contract with, the HMO.

 

Preferred Provider Organization (PPO)

A PPO is a healthcare organization composed of participating (in-network) physicians, hospitals, pharmacies and other providers that agree to provide healthcare services at a reduced fee. PPOs offer more flexibility than HMOs by allowing for visits to non-participating (out-of-network) providers at a greater expense to the member.

 

Point of Service Plan (POS)

A POS plan is a managed care plan that allows members to choose providers or specialists at the time services are needed. The member may choose to use a provider within the POS plan’s network as referred by their primary care physician, or to self-refer to a provider outside the network at a higher out-of-pocket cost.

 

South Carolina  Health Insurance Pool

SCHIP is the South Carolina state high-risk pool. This program allows individual health insurance policies to be sold to people who might otherwise be considered “uninsurable” because of a chronic illness. Premiums may be high, and a pre-existing condition period may apply. Contact SCHIP for more information. (800) 868-2500 ex. 46401

Text Box: Private Insurance – 101 Text Box: Basic Types of Private Health Insurance You should always know what type of insurance you have. There are two main types – Group and Individual. Within these two types there are many products – HMO, PPO, POS.

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