Arizona Major Medical Plans
You’ve probably seen the term “major medical” as you evaluated Arizona health insurance plans online, but maybe you weren’t exactly sure what the term refers to. Let’s explain that term as well as some of the others you may run across in your search.
A medical problem with high costs—such as procedures and/or surgery, is covered under a “major medical plan.” That means all or some of the expenses of a hospital stay, prescription medications and doctor visits associated with these “major” events are covered.
There are several ways the benefit works
If your plan has a deductible, it is probably an indemnity plan. A deductible is the flat fee you pay before the insurance company takes over coverage. Once medical expenses that are covered exceed the deductible amount, the Arizona health insurance company pays your benefits, usually as a percentage of the bill. For example, you may have a plan that reimburses 80 percent of a medical bill and you are responsible for the rest
Health insurance PPOs
Another common term you’ll see as you review Arizona health insurance is a preferred provider organization plan—a PPO plan. A PPO is a major medical plan in which you have choice of hospitals and physicians from a network list the insurer provides. The insurer wants you to use the list, as they have negotiated lower rates with these providers. That’s why it’s called a “preferred provider” network. It is often possible to get treatment off the list, but you will pay a higher co-pay or deductible. Sometimes, though, you won’t get any benefit at all if you use a doctor or hospital that is off-list.
Health insurance HMOs
A health maintenance organization or HMO requires you to get care within its own network. You can select a primary care doctor from the HMO list and that physician will be in charge of all of your medical care.
Specialists are within the network, as well and often your primary care physician must refer you. You will not be reimbursed if you get treatment outside of the network in most plans. However, some plans do allow this, but you are covered at a much lower rate than if you use a network provider.
As you can now see, the terms are fairly straightforward. We hope this helps you better understand some of your options when you compare Arizona health insurance.