Benefits for health plan members over traditional health insurance policies

Health plans provide, offer or arrange coverage for consumers for healthcare. The coverage provided is for designated services in return of a fixed or prepaid premium. The basic types of health plans offered in Florida are:

• Group Model Health Plan

Group model health plan in Florida involves contracting with doctors organized as a partnership, Professional Corporation, or other associations. The health plan provides compensation to the group for contracted services at a negotiated rate. The group further compensates its physicians and hospitals for the healthcare renders to their patients. 

• IPA Health Plan

In this type of health plan, the plan contracts with an association of medical professionals to provide medical services. The IPA in turn contracts with the physicians who continue in their existing individual or group practices.

• Network Model Health Plan

Network health plan in Florida involves contracting with more than one physician group and may contract with single and multi-specialty groups. 

• Staff Model Health Plan 

Staff health plans employs physicians to provide health care to its members. 

What does it means to be a part of a health plan in Florida?

Being a part of a health plan in Florida should mean access to quality care, exercising preventive measures and affordability of healthcare services. 

The first step is the selection of person physicians who would coordinate the healthcare with large team of health care professionals. The main advantage that health plan consumers enjoy is that they have the choice to pick up from a variety of personal physicians.

Moreover, the members of health plans in Florida are encouraged to visit their personal physician as frequently as they deem necessary, which helps in establishing a working relationship with the physician. 

What makes a health plan in Florida good for consumers? 

The quality of a health plan in Florida can be measured in different ways including rate of immunization or the use of prenatal care. On the administrative aspect, it may have issues as how a member is treated on the phone and in person by Health Plan staff.

The Florida Department of Insurance, in conjunction with the Agency for Health Care Administration, screens health plans for their quality and also checks the overall financial stability. 

Benefits for health plan members over traditional health insurance policies:

• 80% of all doctors in health plans are currently board certified.

• As compared to the health plans, the traditional indemnity plans have a lower percentage of certified doctors lying at 60%. 

It is clear that Board certified doctors are screened through a high level of expectation by their peers and the medical community and therefore are expected to provide better healthcare services to the patients.

Moreover, health plans in Florida have full time utilization review departments and full time medical directors to assure that the consumers receive the most appropriate level of care. Major medical decisions of the health plan are reviewed by the medical director or utilization review nurse, who is trained in recognizing acceptable standards of medical practice.

So overall, there are visible advantages of a health plan in Florida over traditional indemnity plans.

Author writes extensively on topics including Health Insurance florida and Low Income Health Insurance florida He has published several write ups on health insurance on various online portals.

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