What is Usually Covered With Individual and family health Insurance?

Individual and family health insurance plans are usually described as either “indemnity” or “managed-care” plans. Put broadly, the major differences concern choice of health care providers, out-of-pocket costs, and how bills are paid.

Typically, indemnity plans offer a broader selection of health care providers than managed-care plans. Indemnity plans pay their share of the costs for covered services only after they receive a bill (which means that you may have to pay upfront and then obtain reimbursement from your health insurance company).

There are several different types of managed-care health insurance plans. These include HMO, PPO, and POS plans. Managed-care plans typically use health care provider networks. Health care providers within a network agree to perform services for managed-care plan patients at pre-negotiated rates and will usually submit the claim to the insurance company for you.

In general, you’ll have less paperwork and lower out-of-pocket costs with a managed-care health insurance plan, and you’ll have a broader choice of health care providers with an indemnity plan.

A set of 10 categories of services health insurance plans must cover under the Affordable Care Act.

These include:

• Doctors’ services
• Inpatient and outpatient hospital care
• Prescription drug coverage,
• Pregnancy and childbirth,
• Mental health services, and more.
• Some plans cover more services.