Choosing between health plans is not as easy as it once was. Even though there is no one "best" policy in Sri Lanka, there are some plans that will sound better than others for you and your family's health requirements. Policies differ, both in terms of how much you have to pay and how easy it is to get the services required. The bitter fact is that no plan will pay for all the costs associated with your medical care. However, some providers will cover more than others. Almost all plans today have ways of reducing unnecessary use of health care and keep down the costs too. This may affect how easily you get the care you want, but should not affect how quickly you get the care you need.
Your Employment Benefits
Policies tend to change from year to year, so you should carefully consider each policy. If you get health insurance as a part of your employment contract, you should start with your employer’s policy provider or the company’s HRM function. They should be able to tell you what is covered under the policy available to you. You can also call provider directly to ask the questions unanswered.
Which Policy – Indemnity or Managed
Health insurance policies are usually described as either indemnity (fee–for–service) or managed care. These types of policies differ in important ways that are described below. With any health plan, however, there is a basic premium, which is how much you or your employers pay, usually monthly, to buy health insurance coverage. In addition, there are often other payments you must make, which will vary by policy. In considering any plan, you should try to figure out its total cost to you and your family, especially if someone in the family has a chronic or serious health condition.
Indemnity and managed care plans differ in their basic approach. Put broadly, the major differences concern choice of providers, out–of–pocket costs for covered services, and how bills are paid. Usually, indemnity plans offer more choice of doctors (including specialists, such as cardiologists and surgeons), hospitals, and other health care providers than managed care plans. Indemnity plans pay their share of the costs of a service only after they receive a bill.
Managed care plans have agreements with certain doctors, hospitals, and health care providers to give a range of services to plan members at reduced cost. In general, you will have less paperwork and lower out–of–pocket costs if you select a managed care type policy and a broader choice of health care providers if you select an indemnity–type policy.
Your Business Matters
Over the years, the distinctions between these kinds of policies have begun to emerge as policy providers compete for your business. Some indemnity policies offer managed care–type options, and some managed care policies offer members the opportunity to use providers who are "outside" the policy. This makes it even more important for you to understand how your health policy works.
