Family Medical Insurance

When seeking family insurance prepare yourself by looking at your family and assessing their health care needs. Ask questions related to their needs and seek the answers in the different family medical insurance options.

For example, here are five questions to get you started:

• Does your child have asthma or a similar illness where he or she will need recurring treatment?
• Do you plan on having more children?
• Do either you or your spouse’s families have any medical history that could impact either of you or your children?
• What can you afford to pay out of pocket?
• What’s your peace of mind threshold in an emergency?

Following are the three major types of family medical insurance to select from:

Fee for Service or Major Medical Plans- These are the most traditional type of plans. You pay a monthly premium and your insurance will pay part of the cost of any treatment you receive.

A facet of this plan that people like is that you can select any doctor you want and go to any hospital in the country. You’re not restricted in any way.

Health Maintenance Organizations (HMO)- This plan provides comprehensive health care with a focus on preventive health in exchange for your monthly premium. That means that routine physicals and mammograms are usually 100% covered after a co-pay. A co-pay is a small charge you pay when you get to the doctor’s office. For example, you might pay a $25 copayment for a doctor’s visit.

However, you will have to use the HMO members as your physicians. In fact, you’ll have to choose a primary care physician. You’ll see him or her first for any kind of treatment.

They will refer you to other doctors if necessary.

Preferred Service Provider (PPO)- This plan isn’t as restrictive with outside doctors as an HMO. With a PPO, you’ll get two coverage levels—an in-network and an out-of-network level.

You’ll pay less if you choose an in-network doctor or hospital. However, if you decide to go out-of-network, you’ll still have coverage.

POS (Point of Service) Plan- These are similar to an HMO in that you’ll have to select a primary care physician. If you need to see a specialist, it’s easier to get an out of network referral from a POS.

Factors that Affect Family Medical Insurance Premiums

You’ll want to make sure you really understand the following features before you choose a family medical plan:

• Deductibles- A deductible is what you pay out of pocket before the insurance begins to pay. The higher the deductible the lower your monthly premium. Make sure you can afford what deductible you choose.

• Copayment- Make sure you check how much your copayment will be when you see your doctor or have to go to the emergency room.

• Coinsurance- This is the amount you’ll pay after the deductible is met. It’s usually 20 percent of the next $5,000 or $10,000 worth of medical charges.

Also, carefully check what medical procedures are covered and not covered so you make the right family insurance decision for your family.

Steve Wyrostek -MedicalInsurance.org Expert A 20 year plus veteran of the insurance industry, Steve managed departments in the personal and commercial lines areas of major insurers. He’s familiar with how insurance—ranging from boat to workers compensation—works.