Posts Tagged ‘health maintenance organization’

2010 Top 10 Health Insurance Companies + Free Health Insurance Quotes from Top Health Carriers

June 28th, 2009

Issued below, a health insurance report card for the top health insurance companies in the United States. Named below are the Top 10 Commercial Companies, the Top 5 Best Medicare Plans, and the Top 5 Medicaid Plans. Each plan considered for the ranking was rated between 0 and 100. Scores were based on data from the National Committee for Quality Assurance. After reviewing the top 10 health insurance companies feel free to stop over for a Free Life Insurance Quote from all the Top Carriers.

Top 10 Commercial Plans:

1.) Harvard Pilgrim Health Care

Score: 91.7
Serves: Maine, Massachusetts
93 Worcester Street
Wellesley, MA 02481
Harvard Pilgrim Health Care has been in business for more than 35 years, and they have continually won awards for their stellar health care plans and practices.

2.) Tufts Associated Health Maintenance Organization

Score: 90.8
Serves: Massachusetts, New Hampshire, Rhode Island
705 Mount Auburn Street
Watertown, MA 02472-1508
617-972-9400
In 1979, Tufts was founded as a not-for-profit health maintenance organization. Today, plan benefits can include chiropractic care, acupuncture, and massage.

3.) Harvard Pilgrim Health Care of New England

Score: 90.6
Serves: New Hampshire
93 Worcester Street
Wellesley, MA 02481

4.) Blue Cross and Blue Shield of Massachusetts

Score: 89
Serves: Massachusetts
Landmark Center
401 Park Drive
Boston, MA 02215-3326

Blue Cross and Blue Shield of Massachusetts is in the process of developing a statewide electronic medical records system. They are also working on ways to provide insurance for the estimated 500,000 uninsureds in Massachusetts.

5.) ConnectiCare

Score: 88.9
Serves: Connecticut
175 Scott Swamp Road
P.O. Box 4050
Farmington, CT 06034-4050
ConnectiCare was founded in 1981. They serve more than 240,000 individuals.

6.) Health Net of Connecticut

Score: 88.6
Serves: Connecticut
1-888-802-7001
Health Net offers individual, group, dental, and vision healthcare options.

7.) Excellus BlueCross, Blue Shield, Rochester Region

Score: 88.4
Serves: New York
P.O. Box 22999
Rochester, NY 14692
Blue Cross Blue Shield Rochester Region is part of an enterprise that ensures more than 2 million people and employs more than 6,000 New Yorkers.

8.) Group Health Cooperative of South Central Wisconsin

Score: 88.3
Serves: Wisconsin
1265 John Q. Hammons Drive
P.O. Box 44971
Madison, WI 53744-4971
Group Health Cooperative was founded in 1976 as a not-for-profit member-sponsored health maintenance organization.

9.) Health New England

Score: 88.2
Serves: Connecticut, Massachusetts
(800) 842-4464.
Health New England offers individual and group health insurance policies. They are based in Massachusetts.

10.) Anthem Blue Cross and Blue Shield-Connecticut

Score: 88.2
Serves: Connecticut
Operations Center and East Headquarters
370 Bassett Road
North Haven, CT 06473
(203) 239-4911

In addition to offering comprehensive health insurance, Anthem Blue Cross and Blue Shield-Connecticut also offers dental, life insurance, and pharmacy benefits.

Best Medicare Plans

  1. Fallon Community Health Plan
  2. Blue Cross and Blue Shield of Massachusetts
  3. Tufts Associated Health Maintenance Organization
  4. Preferred Care
  5. Kaiser Foundation Health Plan of the Northwest

Best Medicaid Plans

  1. Fallon Community Health Plan
  2. Neighborhood Health Plan of Rhode Island
  3. Blue Cross & Blue Shield of Rhode Island
  4. Capital District Physicians’ Health Plan
  5. Excellus BlueShield, Rochester Region

If you are searching for a health care plan for yourself, your family, or your employees, consider the excellent, above mentioned providers and plans.

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Health Insurance Guide

June 22nd, 2009

Health has always been uncertain. We can try our best to keep fit, but after a certain age the expenses on health do increase. Its better to keep ourselves insured under a Medical Plan to make sure that our medical expenses are taken care of.

If we talk about Individual Health Insurance Plans in US, they are designed to help an individual and their families access care and cover the medical cost of receiving medical services from any physician, hospital or other provider.

There are different types of Medical Plans:

  • Indemnity
  • Health Maintenance Organization
  • Preferred Provider Organization
  • Point of Service Plan
  • Exclusive Provider Organization
  • Consumer-Driven

Health Insurance Portability and Accountability Act (HIPAA) Privacy – Protected Health Information.

Under HIPAA Privacy, unauthorized individuals cannot ask or inquire about any clinical or personal health information when counseling participants about their Medical Plans.

Indemnity Plans – These plans are sometimes called “Free-for-Service” Plans, where:

  • An individual pays the medical care provider directly for services
  • Files claim to be reimbursed by the Plan

An Individual can seek care from any doctor or hospital and receive benefits.

Hospital precertification is required for some services in order to receive the highest level of benefits.

This plan:

  • Pays reasonable and customary deductible coinsurance amounts, up to an out-of-pocket maximum
  • Rely on Utilization Management to control costs

Health Maintenance Organization (HMO) – An HMO provides prepaid benefits for most health care needs with no bills or claim forms. It provides services through a selected group of doctors, hospitals and other providers who are under contract to the HMO. To choose an HMO option, an individual must live or work in an area supported by the HMO network – as defined by their home ZIP Codes.

  • An individual choose a Primary Care Physician (PCP) from a list of physicians
  • They pay copayment (instead of deductibles) each time they visit a provider
  • Services rendered by the PCP or from a provider referred by PCP is reimbursed
  • HMOs provide preventive care and rely on Utilization Management to control costs

Preferred Provider Organization (PPO) – A PPO is a network of contracted participating physicians and hospitals that agree to render their services at discounted rates.

PPOs maintain networks of participating doctors and hospitals; however, individuals are not required to choose a PCP to coordinate their care. They have the choice of using in-network and out-of-network providers, using in-network providers offers higher benefits though.

Point of Service Plan (POS) – POS Plans have networks of participating doctors and hospitals that provide medical care at negotiable rate.

  • Individuals living in a POS service area, according to their home ZIP Codes, are eligible to join the plan and must choose an in-network PCP or facility from the list of providers
  • Using in-network providers offer the highest level of benefits

Exclusive Provider Organization (EPO) – EPO Plan resembles to HMO. Benefits are provided within a specific contracted network of physicians and hospitals with no out-of-network benefits available.

  • Individual chooses a PCP from the list of physicians
  • Individual are required to pay a predetermined copayment (instead of a deductible) each time they visit a provider.
  • Services rendered by PCP or by a provider referred by the PCP will be reimbursed
  • EPOs provide preventive care and rely on Utilization Management to control costs

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