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Commercial Health Insurance

by Admin on October 28, 2011

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ometimes referred to as private insurance, Commercial Health Insurance is any kind of health insurance that is not managed or offered by the government or government-owned or controlled entity. Companies that offer commercial health insurance are for-profit entities who offer insurance services as personal or individual plans or through group plans. In all instances, only those who are able to pay premiums for insurance coverage are offered commercial insurance.

Insurance Plan

Often, an employer provides access to commercial insurance by way of a group insurance plan. This is available to employees who qualify because they’ve met the criteria set by the employer. The criteria could be in terms of number of hours worked, the length of time the employee has been with the company, or some other similar factor taken into consideration by the employer. Payment for the insurance program may vary. The employer has the options of either paying for the entire amount of the premium payments or covers only a part of said premium. When the latter situation is applied, the employee is made to pay the unpaid balance usually through payroll deductions.

The 3 Most Common Commercial Health Insurances:


1. Point of Service Plan

While there are numerous kinds of commercial health care, only the three most common types shall be discussed here. Most popular of these is the point of service plan. This is the kind of coverage that permits the plan holder to select a primary care physician from a list supplied by the insurance company. By availing of the services of those provided in the list of healthcare professionals the insurance holder is ensured of a larger share of the expenses incurred by way of professional fees under the terms of the insurance contract. If a healthcare professional outside the list is chosen, the coverage of the bill by the insurance company is reduced.

2. Health Maintenance Organization

The Health Maintenance Organization (HMO) is another popular choice. Similar to the point of service system, members of an HMO selects a primary care physician from a list of healthcare professionals compiled by the insurance provider. Should there be a need to consult with a specialist, there must be an official referral made by the primary care physician to said specialist. This kind of coverage seldom cover healthcare from outside the approved professionals in the list provided, except in very rare occasions.

3. Indemnity Model

The indemnity model or fee-for-service is the third option discussed here. In this type of coverage, a list of specific healthcare procedure is provided by the insurer. The insurance holder has free range in choosing the healthcare professional so long as the care provided is within the purvey of the list of procedures provided. This type of plan tends to be limited in coverage, but more comprehensive plans are available.

When choosing a commercial health insurance, it is imperative that measures are taken to ensure adequate coverage. This involves studying the terms of the contract with the utmost care, ensuring that they are acceptable to both parties.





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