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What Is Comprehensive Medical Insurance?

by
author image Jennifer Terry
Jennifer Terry is program director for TriCounty Agency for Intellectual Disabilities. As a University of Alabama graduate, she holds a Masters in rehabilitation counseling and a Bachelor in psychology with an emphasis in child development. She also earned an Associate in business management and second Associate in computer information systems from Bevill State Community College. She holds a grant writing certificate from North Georgia College and State University.
What Is Comprehensive Medical Insurance?
A patient is talking to his doctor. Photo Credit Comstock/Stockbyte/Getty Images

Comprehensive medical plans originated in the 1930s with industrialists Henry Kaiser and Dr. Sidney Garfield. Dr. Garfield, at Kaiser’s request, created a health plan to protect the workers of the Grand Coulee Dam. They expanded the healthcare plan in the 1940s to include Kaisers numerous shipbuilders. By the end of World War II, other employers decided to offer similar benefits and implemented a comprehensive medical plan to insure all their employees.

Comprehensive Medical Insurance Basics

Comprehensive medical insurance utilizes a network of physicians and healthcare facilities along with other medical professionals to provide healthcare to families and individuals. The insurance company offers patient incentives to use physicians and healthcare workers within the network by offering maximum coverage for these choices. Approval must be given to see a specialist. Traditional insurance plans offer much more freedom to choose the physicians and healthcare providers, but comprehensive medical insurance is typically less expensive.

Providers

The physicians and healthcare providers of comprehensive medical insurance usually fall under four categories: HMO, PPO, POS, FFS.

Health Maintenance Organization (HMO) utilizes a primary care physician, chosen by the patient, from a predetermined group of participating doctors. This physician refers family members to all specialists.

Preferred Provider Organization (PPO) coverage allows the family to see a doctor not in the network. This physician refers family members to specialists as with HMO's. PPO is similar to traditional health plans but with the savings of managed healthcare.

Point of Service Plan (POS) coverage allows the family to pick their own specialist when one is needed. The primary doctor is still in place for the family to receive general medical care.

Fee for Service Plan (FFS) coverage provides the most options and fewer restrictions. The family can use any provider they choose. FFS plans are more expensive than other types of comprehensive medical insurance plans.

Types

There are two classes of comprehensive medical insurance: group and individual.
An employer provides group comprehensive insurance to employees. People purchase individual comprehensive insurance on the open market. Individual insurance offers fewer benefits than group insurance and is often more expensive.

Costs

Comprehensive medical insurance requires a monthly premium, a deductible, and co-pays. The insured pay out money for medical related bills until the deductible and out-of-pocket caps have been reached. Co-pays typically continue depending on the specific plan. Monthly premiums continue throughout the coverage period. The amount of the deductible and the premiums differ depending on age, health status, type of plan, depth of the plan and any additional coverage the individual chooses to add.

Traditional and Comprehensive Coverage Differences

Traditional insurance plans offer more freedom and flexibility than comprehensive plans. Because of this freedom, the rates for traditional insurance are higher than comprehensive insurance. Comprehensive plan holder has a network of doctors to choose from under most plans compared to the freedom of choice traditional plans offer.

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