Health insurance in its purest sense is to protect you from catastrophic medical claims that would otherwise have a major impact on your financial affairs. In designing a plan a simple rule is that the broader the coverage and the less restrictive the coverage, the greater the premium will be.

There are several types of health insurance plans that individuals and families can consider. Your wallet, your doctor relationships, your health and your tolerance are the greatest factors in determining the most appropriate coverage for you.

There are basically four types of insurance options to consider: Indemnity (total freedom of choice), HMO, PPO and MSAs. Indemnity plans are rare in today's marketplace because of price and the major savings afforded by PPO plans. Indemnity plans allow the insured to simply get medical care from their selected doctors, labs and facilities.

PPO plans (Participating Provider Option) offer the freedom of choice advantages of an indemnity plan, but also allow for a substantial discount when services are rendered by a PPO participating provider. There are no referral requirements under a PPO plan; benefits are discounted simply because the provider has agreed to a pre-determined contracted fee for services.

HMO plans are the most restrictive and cost competitive option. HMO plans typically are also more tolerant of medical conditions. Indemnity and PPO plans may put restrictions or riders on specific pre-existing conditions. HMO plans will either accept or reject, and typically will not place any restrictions on pre-existing conditions. Some individuals do not like the requirement that all care be directed through a pre-selected Primary Care Physician (PCP). Even though getting referrals can be burdensome, there are several positive tradeoffs. First of all, networks are generally very large and include most physicians and hospitals. Second, the insured does not have to worry about balanced billed charges as long as services were directed by the PCP. Even out of network emergencies are considered in-network if it is a true medical emergency and the insured contacts the PCP within a required period of time.

POS plans (Point of Service) are similar to PPO plans but with the requirement of referrals when utilizing the higher level in-network benefits. The advantage of the POS plan is that allows the insured to take advantage of the high level of benefits afforded by HMO plans, while at the same time allowing the insured to seek care out of network subject to higher out of pocket costs. Nevertheless, it allows for freedom of choice in the event of a serious medical condition.

MSA (Medical Savings Accounts) are plans that are reserved for sole proprietors (and in some states employer groups). In general, the concept of an MSA is to allow the individual to select a very high deductible plan and set up a special account called a Medical Savings Account to self fund for the smaller claims. In the long run, there is a great potential for savings. The medical savings account grows tax deferred and can be accessed tax free if used for IRS approved medical expenses.

When individuals ask us to research health insurance we go through specific steps to determine the most appropriate coverage. Consider the following before selecting a plan design or carrier:

	How is your health? If you are relatively healthy (colds, flu, etc.), all options may be available to you. MSA plans are only available to the self-employed individual. Other minor conditions may or may not be a problem depending on the insurance company. Remember you do not pay any more cost to use the services of a broker than you would if you went directly to the insurer. Be open with the broker so that he/she can give you a realistic assessment of your options.
	Check the insurance company network to determine if your family medical providers are participating with the specific networks being considered. If all of your important doctor relationships are in network, it might be very easy to comply with the rules of a specific HMO, POS or PPO plan. If an important doctor is not in, you want to be sure that you have a strong out-of-network benefit, i.e., POS or PPO. If you are likely to select a POS or PPO plan, make sure that you understand specifically how the carrier will base their out-of-network fees when they compensate non- participating providers. It is important that you understand that even if the plan says it pays 80% out of network, they really mean 80% of what the insurer deems to be an acceptable fee. If they're low, you will be balanced billed by the provider.
	Compare the premiums of the plans that meet your needs. Jolles Insurance represents most of the major carriers in the Maryland, DC, Virginia marketplace. We look forward to the opportunity to research your options and help you determine the best plan design and carrier to meet your needs. We not only offer complete research for finding the best plan, we help you through the underwriting process, and provide extra first class service as long as you are our client.

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