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Medical
insurance benefits
In a move to "put consumers in the driver's seat," Health Net of
California, one of the state's largest health plans, has launched
the new Medical insurance benefits program. The Medical insurance
benefits gives consumers the flexibility, choice and decision-making
power to take charge of their health care coverage, while preserving
affordability and ease of use. It offers Californians a new avenue
for health coverage. It's a preferred provider organization (PPO)
product design that allows Californians to enjoy the selection and
personal choice they want, while providing the savings that so many
desire in light of the changing economy.
The Medical insurance benefits's First Advantage, currently offered
to employer groups of 50 or more, is unlike traditional PPOs. It
utilizes a "first dollar benefit" in which 100% of each member's
yearly eligible medical expenses, up to a predetermined ceiling,
are paid before the member becomes responsible for paying their
yearly deductible. With traditional PPOs, members pay their deductibles
before plan coverage begins, not after. For example, with the Medical
insurance benefits standard plan (plans may vary depending upon
each employer's agreement with Health Net), members' first $500
of medical costs are fully covered. Then, after satisfying a $1,000
deductible, members pay 20% for medical care that is obtained from
within Health Net's vast network of contracted physicians.
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In
addition, the premium is usually very affordable. Some who have
signed up for the Medical insurance benefits plan have reported
that their savings in monthly premiums have dropped by nearly 80%.
For most, the money saved in monthly premiums more than covers the
$1,000 deductible.
Health Net's Medical insurance benefits members have two options
when choosing their doctors. Members can pay a discounted rate for
their care by using any of Health Net's 49,000 contracted health
care providers, or they may pay regular rates by visiting physicians
outside the network The choice is with the member, and so is the
power to control how prudent they are with their first $500. Although
costs are difficult to estimate, it's surprising how far $500 can
go. One of the challenges that employees face when considering whether
to sign up for the Medical insurance benefits plan is estimating
potential medical expenses. In California, the average doctor's
office visit costs $60, lab fees average approximately $30, an X-ray
in a doctor's office is approximately $135, and an emergency room
visit is approximately $475. When utilizing the "first dollar benefit"
of $500, it is possible that Health Net's Medical insurance benefits
members may have a wide range of services covered at no out-of-pocket
cost. And, because members pay the Health Net contracted rate, their
health care dollar goes even further!
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