Health insurance: How does it work in the US?
If your company doesn’t take over your health insurance, you will have to do it by yourself. The information below should help your understanding better the American health system.
PPO (Preferred Provider Organization)
The PPO is a managed care organization of medical doctors, hospitals and other health care providers who have covenanted with an insurer or a third-party administrator to provide health care at reduced rates to the insurer’s or administrator’s clients.
Cela signifie que vous ne pourrez consulter que les medecins qui ont ete acredites par l’assureur. Dans le cas contraire, l’assurance ne prend pas en charge les frais medicaux.
HMO (Health Maintenance Organization)
HMOs often require members to select a primary care physician (PCP), a doctor who acts as a “gatekeeper” to direct access to medical services but this is not always the case. Except in medical emergency situations, patients need a referral from the PCP in order to see a specialist or other doctor, and the gatekeeper cannot authorize that referral unless the HMO guidelines deem it necessary.
Copayment or copay is a payment defined in the insurance policy and paid by the insured person each time a medical service is accessed. It must be paid before any policy benefit is payable by an insurance company.
Insurance companies use copayments to share health care costs to prevent moral hazard. Though the copay is often a small portion of the actual cost of the medical service, it is meant to prevent people from seeking medical care that may not be necessary
Your employer decide or not to sponsor a Flexible Spending Account, or “Flex Plan” as one of your insurance benefits.
Flex is an IRS-approved method of paying for your “out-of-pocket” Health, Dental, Vision, & qualified Over-The-Counter expenses with set aside “pre-tax” dollars.
Why Participate In a Flex-Plan?
Participation in a Flex-Plan saves you money by deducting the Flex set-aside dollars from your wages before taxes, making only the wages remaining subject to taxes. Through your employer’s Flex Plan, you can pay many of the following bills with your pre-tax dollars : Medical, Dental, Vision, qualified Over-The-Counter (OTC) medications, dependent care. By setting aside dollars for those
expenses in a Flex Plan, most employees will save between 25% and 40% in taxes.
Here are the main contacts if you need to go to the hospital.
Depending on your illness, you will have the choice between three different options
- Medical care includes primary physicians
- Urgent Care, days or hours your primary physician isn’t available (holidays, week ends, evenings)
- Emergencies, just for real emergencies! The cost is extremely high and the wait is very long.
We have listed for you multilingual doctors who will be more than happy to practise French!.
Dr Julie et Joseph Boulos: dentist (speaks English & French)
All Coast Dental is a family and cosmetic dentistry. Dr Joseph Boulos speaks fluently French and English. Dr Joseph and Dr Julie offer a high quality dentistry using the most modern dental techniques and materials available for your dental care. They offer a wide range of services in general dentistry including periodontal laser therapy, cosmetic dentistry, root canal treatment, crown and bridge, pediatric dentistry, tooth removal, dentures, and teeth whitening.
2180 Garnet Avenue, Suite 1-K
Pacific Beach, CA 92109
Dr Veronique James : pediatrician (speaks English and French)
Scripps Memorial Hospital
4150 Regents Park Row Ste 355
La Jolla, CA 92037
Phone : 858-457-2043
Dr Rita Feghali : pediatrician (speaks French, English, Spanish, Italian, German and Arab)
4405 Vandever Avenue
San Diego, CA 92120
Phone : 619-516-6170
Dr Martin Kabongo : family doctor, pediatrician and gynecologist (speaks French and English)
9909 Mira Mesa blvd
San Diego, CA 92120