Florida Department of Financial Services Guide To Florida Health Insurance

Nobody plans on getting sick or injured. But life is full of unexpected events that force us to seek medical care. These include everything from a common cold to a more prolonged illness or injury. When these situations arise, your best financial defense is to have adequate health insurance.
Health insurance can help protect your assets and pay medical expenses, but selecting the policy to best meet your needs can be challenging. This guide explains the various types of policies that are available, offers tips on choosing a policy and provides definitions for the numerous health insurance terms you may encounter.  
Your first health insurance choice may be to decide between traditional health insurance and a managed care option. With traditional health insurance, you – the policyholder – select a health care provider, such as a doctor or hospital.
You may have to pay for services when rendered and then submit the bill to the insurance company for reimbursement of the portion it agreed to pay under the policy terms. Frequently, the provider will submit the bill directly to the insurer and await payment.
The managed care system combines the delivery and financing of health care services. This limits your choice of doctors and hospitals. In return for this limited choice, however, you usually pay less for medical care (i.e., doctor visits, prescriptions, surgery and other covered benefits) than you would with traditional health insurance. The managed care network controls health care services.
You may obtain the free publication Health Maintenance Organizations: A Guide for Consumers by calling the Consumer Helpline toll-free at 1-877-MY-FL-CFO (1-877-693-5236), or by downloading it from the DFS Web site at www.MyFloridaCFO.com.
Exclusive Provider Organizations (EPOs) In an EPO arrangement, an insurance company contracts with hospitals or specific providers. Insured members must use the contracted hospitals or providers to receive benefits from these plans. Preferred Provider Organizations (PPOs) A PPO offers another kind of provider network to meet the health care needs of consumers. A traditional insurance carrier provides the health benefits. An insurer contracts with a group of health care providers to control the cost of providing benefits to consumers. These providers charge lower-than-usual fees because they require prompt payment and serve a greater number of patients. Consumers usually choose who will provide their health services, but pay less in coinsurance with a preferred provider than with a non-preferred provider.
Point-of-Service Plans These plans may be called by a variety of names and have various features. They combine some aspects of traditional medical expense insurance plans and other aspects of HMOs and PPOs. In a POS plan, insured members may choose, at the point of service, whether to receive care from a physician within the plan’s network or to go out of the network for services. The POS plan provides less coverage for health care expenses provided outside the network than for expenses incurred within the network. Also, the POS plan will usually require you to pay deductibles and coinsurance costs for medical care received out of network.


From: http://www.echealthinsurance.com/florida-health-insurance-guide.html