Health Plan vs. Health Insurance

April 24, 2008 by rainier  

Historically, HMOs tended to use the term “health plan”, while commercial insurance companies used the term “health insurance“. A health plan can also refer to a subscription-based medical care arrangement offered through health maintenance organization, HMO, PPO, or POS plan. These plans are similar to pre-paid dental, pre-paid legal, and pre-paid vision plans. Pre-paid health plans typically pay for a fixed number of services (for instance, $300 in preventive care, a certain number of days of hospice care or care in a skilled nursing facility, a fixed number of home health visits, a fixed number of spinal manipulation charges, etc.) The services offered are usually at the discretion of a utilization review nurse who is often contracted through the managed care entity providing the subscription health plan. This determination may be made either prior to or after hospital admission (concurrent utilization review).

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  1. [...] are prepaid health plans. The typical HMO provides a broad range of services. You (or your employer) pay a monthly premium [...]

  2. [...] to providers and services are controlled, and how much authority the enrollee has to design her/his health plan. While delivery systems may share certain characteristics, general distinctions can be made based [...]



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