Flexible Health Plans With A Trap

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Consumers are choosing flexible health plans outside the network of insurers. These plans paid the doctor and hospital bills that are not covered by the core plan. These health plans also fix an annual cap on what amount is paid to the policyholders outside the insurer’s network. Now the situation has changed. The preferred provider plans or PPF are offering no ceiling on out of network costs. Now consumers that choose these services can enjoy unlimited financial exposure in comparison to restrictive coverage like health maintenance organizations that are imposed on those who avail out of network services.

Around 45 percent of silver level PPOs offers zero annual caps for out of network insurers’ policyholders. Robert Wood Johnson Foundation finds this in an analysis. The benefit an uncapped plan can bring to the patient is tens of thousands of dollars in hospital bills for those patients that are not otherwise part of the plan. Around 14 percent of the current silver level PPOs comes with zero ceiling on out of network insurers. With new plans entering the market and the current plans continuing, the percentage is likely to be doubled.

According to RWJF analysis, the unrestricted cap for outside the network insurers for a person under the silver level PPOs is put at $16,700. This may not be a precise comparison, and the statistics by Mercer, a benefits firm has it that the midpoint cap for job based insurance for workers is $6,000 per individual and $12,000 per family. Though the law regulates what the insurers charge policyholders on an annual basis.

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