With a company sponsored healthcare benefits program, employees are free from worrying about the costs of medical care. It also keeps them healthy, more productive, engaged, satisfied and less absent from work.
Health Maintenance Organization or HMO Plans provides health services and benefits to members in exchange for a fixed annual membership fee.
The concept behind an HMO program is Managed Care. HMOs arrange contractual agreements with their network of accredited doctors, clinics, laboratories and hospitals that regulate cost while maintaining quality of care. By managing cost of health services availed through their network, HMOs are able to provide members with comprehensive benefits and services that cost less than what you would have paid as a private paying patient.
Plans that employers can choose from are based on Room & Board Accommodation (Ward, Semi Private, Private, Suite) and a choice of either a Maximum or Annual Benefit Limit per member per year. Maximum Benefit Limit or MBL provides coverage of members on a per illness per year basis while an Annual Benefit Limit or ABL provides coverage on a total aggregate limit per member per year.
Medical insurance is defined as insurance against the risk of incurring medical expenses among individuals. It reimburses medical expenses incurred by members as a result of sickness or injury as well as losses from accident, disability, or accidental death and dismemberment.
In terms of design, Medical insurance sets internal limits on reimbursable expenses for out patient consultations, laboratory and diagnostic services, room and board allowance per day, surgical rates, professional fees, etc.
While HMOs provide benefits and services exclusively within an accredited network, Medical Insurance allows insured individuals to avail of medical services from their own preferred physicians or healthcare provider.
In terms of coverage, medical insurance does not impose a Maximum Benefit Limit or Annual Benefit Limit. Limits are automatically refreshed quarterly or every 90 days per disability.
Need expert advise? Not satisfied with your healthcare benefits? Are you paying too much? Need help with managing your healthcare plan? Are you drowning in complaints? Not happy with the service you receive?