Private
Insurance
Self-Insured
This is typically an employer or employee group who may set aside funds and employee premiums
each month to pay health coverage claims submitted to the plan. Plans are directed by the U.S.
Department of Labor under the Employee Retirement and Income Security Act (ERISA). Example
would be large corporations that provide their own insurance.

Fully-Insured
Some employer or employee groups purchase health insurance coverage from an insurance company.
Others may purchase group health coverage from a health maintenance organization or “HMO”.
(Examples would include Aetna, Humana, etc) The Indiana Department of Insurance regulates Indiana
insurers of such plans.
  • Health Maintenance Organization (HMO)-Health services through a network of doctors,
    hospitals, laboratories, etc. You choose one of the doctors as your primary care physician (PCP)
    to manage all of your health care. Whenever you need health care, you first consult your
    primary care physician. Your PCP may refer you to an HMO-approved specialist.
  • Preferred Provider Organization (PPO)-A group of doctors, hospitals, and other health care
    providers (preferred providers) who have agreed to provide services to members of a health
    plan for discounted fees.
  • Point of Service Plans-These plans are essentially HMOs that allow members to use services
    provided outside of the network without prior approval from a network doctor. Point of service
    plans offer lower deductibles and no coinsurance for visits to doctors inside the network. Visits
    outside the network normally require the payment of deductibles and coinsurance the same as
    a standard insurance policy.


Miscellaneous info:
  • Mental Health Parity Act of 1996 applies to individuals who have mental health coverage in their
    benefits package. It requires insurers to cover mental health services in the same way as
    medical health and surgical services. It does not require a health plan to cover mental health if it
    does not already and does not apply to benefits for substance abuse or chemical dependency.
  • Mental Health Parity and Addiction Equity Act of 2008 (MHPAEA) expanded what is covered
    under the Mental Health Parity Act by including substance abuse treatment and imposed
    additional provisions.
  • House Bill 1678 requires that individual insurers, group insurers and HMO’s provide coverage
    for an insured child up to age 24 years.

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