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	<artname>Health Insurance - How It Works</artname>
	<image file="../articles/images/health-insurance.jpg" align="left" alt="Emergency room at the hospital"/>
	Without health insurance, a single illness can cause serious, and often
            irrevocable, financial hardship.
            <p>Insurance of any kind is intended to
            transfer financial risk to an insurance company in exchange for a
            reasonable insurance premium. Where most insurance coverages
            pay once a loss has occurred, health insurance has the added benefit
            of paying to keep your loss from getting worse.</p>
            <p>Health insurance is probably your
            most important coverage since it can be the difference between life
            and death.</p>
            <p>Fortunately, most employers offer
            some form of health insurance. Often you will have to select from
            several different alternative plans with differing coverages and
            premiums.</p>
            <p>There are two broad categories of
            health insurance coverage. One is <i>fee-for-service</i> and the
            other is <i>managed health care</i>. Under managed health care there
            are health maintenance organizations (HMOs), preferred provider
            organizations (PPOs), and point-of-service (POS) plans.</p>
	<artsub>Fee-For-Service</artsub>
            <p>Fee-for-service and managed health
            plans have distinct differences in the amount of control the
            policyholder has in choosing doctors and hospitals. Although fee-for-		     service plans are becoming less common, they offer you the greatest 		     amount of choices - allowing you to select doctors and hospitals based 	     on your needs and preferences. This greater amount of choice comes at a 	     cost as fee for service plans are usually more expensive than managed 		     care plans.</p>
            <p>Under a traditional fee for service plan, your
            doctor will submit a bill to your insurance provider, or, if he or
            she does not have a relationship with your provider, you may have to
            pay the bill directly and get reimbursed by your provider.
            Under this plan you can see any doctor you wish. You will most
            likely be responsible for a percentage of every expense, often 20%.</p>
            <p>Traditional fee-for-service plans also have an
            annual deductible; $200 is typical.  Generally speaking, the higher the 	     deductible, the lower your premiums. Before receiving the reimbursement    	     you'll have to pay the deductible amount.</p>
            <p>If your doctor charges more than is
            &quot;reasonable,&quot; you will have to pay the difference. You can
            appeal this if you feel the doctor is charging the same as the other
            doctors around your area.</p>
            <p>Under fee for service plans there is
            usually a limit to how much you will have to pay before the plan
            reimburses you at 100%. Some plans also have a lifetime limit on
            benefits, usually at least $1,000,000. This seems very high but it
            is not uncommon in serious situations that this number is met.</p>
	<artsub>Managed Care</artsub>
            <p>There are three major types of
            managed care health plans: HMOs, PPOs, and POSs. Many of these plans
            charge a co-payment of $25 a visit. The disadvantage of an
            HMO is that you must use the doctor and hospitals that participate
            in the plan. The premiums are generally lower than fee-for-service
            plans.</p>
            <p>With a managed care plan you will
            have to select a primary physician who will be responsible for
            coordinating your care. You will need to be approved by him to seek
            care by a specialist. You must also get authorization for any
            hospitalization you may require. As you can see, the lower
            premiums associated with managed care are the result of allowing the
            managed care provider to make many of your health care decisions for
            you.</p>
            <p>PPOs and POSs differ from HMOs in
            that not only do they have a network of providers, but you are also
            allowed to use physicians outside the network.</p>
	<artsub>Other Considerations</artsub>
            <p>With the passing of the Affordable Care Act, employers with more than 	     50 employees are required to provide health coverage to full-time 		     employees or else pay a tax penalty. However, because the high costs, 		     some employers will find it more cost effective may choose to send their 	     employees to their state health insurance exchanges and provide their 		     employees with a Health Reimbursement Arrangement, which will reimburse 	     a portion of their employees cost.</p>
          
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