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 two types of insurance options to consider: HMO and PPO plans. Health Savings Accounts (HSA) plans are avaialbe with both High Deductible HMO's and PPO's.

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. One way to bring down the premium cost is to consider an HSA PPO, this high deductible plan allows you to put funds into a savings account, and receive tax savings.  When funds are withdrawn for qualified health expenses, they come out tax free.  click here for more details.

HMO plans are the most restrictive and cost competitive option.  One way to bring down the premium cost is to consider an HSA HMO, this high deductible plan allows you to put funds into a savings account, and receive tax savings.  When funds are withdrawn for qualified health expenses, they come out tax free.  click here for more details.  HMO plans typically are also more tolerant of medical conditions. 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.

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.  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,  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.,  PPO. If you are likely to select 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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