Health Insurance Coverage Options
Choosing a Health Insurance Plan
Selecting the right health plan is critical to ensure that your family's medical care expenses are paid. Before deciding on a health plan, it is important to get as much information as possible.
Take advantage of information provided by your employer. Read the written materials provided and discuss your questions with the plan representative. Ask for a provider directory, a subscriber handbook and a summary of health care benefits. Make sure you have contact information for the plan representative or provider relations.
Managed Care Plans
Cincinnati Children's Hospital Medical Center is a provider for most managed care organizations in the Cincinnati area. Our goal is to maintain open access for all managed care organizations, regardless of location.
Parents should contact their managed care organization or insurer to verify benefits and coverage.
Traditional Health Insurance Plans
Most people who have traditional indemnity coverage indicate the reason they like this coverage is the freedom to choose their provider of care. The "traditional plans" do not have requirements for networks or specific hospitals.
The methodology used in traditional plans to pay for services is typically the "80 / 20 deductibles" for hospital services, co-pays, physician services and therapy visits. This means that you, as the subscriber, must pay a deductible amount before the insurance company will pay anything on your bills.
Deductible amounts can vary and differ based on individual or family coverage. Once the deductible has been met, the insurance company will pay 80% of the billed charges. The subscriber will pay the remaining 20%.
Plans now require general and specialty utilization management, catastrophic or large case management and workers' compensation utilization management.
Fee-for-service coverage offers flexibility in exchange for increased paperwork, higher out-of-pocket expenses and higher premiums for the subscriber.
