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California
Health Insurance
& Medical Coverage Plans
We allow you to compare companies
to get low cost, California individual or group health insurance.
Not sure what type of health insurance
is best for you? Read our section on the differences between
a PPO and HMO.
Answers to
some basic, but
important questions, regarding health insurance.
 What
is a PPO? A
Preferred Provider Organization (PPO) is an arrangement
designed to supply healthcare services at a discounted cost
by providing incentives for members to use designated
healthcare providers (who contract with the PPO at a
discount), but which also provides coverage for services
rendered by healthcare providers who are not part of the PPO
network.
What is an HMO? HMO
stands for Health Maintenance Organization, a healthcare
system that assumes or shares both the financial risks and
the delivery risks associated with providing comprehensive
medical services to a voluntarily enrolled population in a
particular geographic area, usually in return for a fixed,
prepaid fee.
What is a Primary Care Physician (PCP)? A physician
or other medical professional who serves as a group member's
first contact with a plan's healthcare system. Also known as
a primary care provider, personal care physician, or
personal care provider.
What is a Claim? An itemized statement of healthcare services and their costs provided by a hospital,
physician's office, or other provider facility. Claims are submitted to the insurer
or managed care plan by either the plan member or the provider for payment of the
costs incurred.physician
or other medical professional who serves as a group member's
first contact with a plan's healthcare system. Also known as
a primary care provider, personal care physician, or
personal care provider.
What is Coinsurance? A method of cost-sharing in a health insurance policy that requires a group member
to pay a stated percentage of all remaining eligible medical expenses after the deductible
amount has been paid. incurred. physician
or other medical professional who serves as a group member's
first contact with a plan's healthcare system. Also known as
a primary care provider, personal care physician, or
personal care provider.
What is Copayment? A specified dollar amount that a member must pay out-of-pocket for a specified service
at the time the service is rendered.
What is a Fee Schedule? The fee determined by an
acceptable for a procedure or service, which the
physician agrees to accept as payment in full. Also known as a fee allowance, fee
maximum, or capped fee.
What is a Generic Substitution? The dispensing
of a drug that is the generic equivalent of a drug listed
on a pharmacy benefit management plan's formulary. In
most cases, generic substitution can be performed without
physician approval.
What is Managed Care? The integration of both the financing and delivery of healthcare within a system
that seeks to manage the accessibility, cost, and quality of that care.
Medical
Resources
As
your medical insurance broker, we want to provide you with
as much valuable health related information as possible. We
are constantly searching the Internet for important,
reputable sites where you can find information that can
better prepare you to deal with the health related issues
you confront.
CLICK
HERE
to see a comprehensive list of medical information on the
internet.
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