Individual and family health insurance plans are usually described as either “indemnity” or “managed-care” plans. Put broadly, the major differences concern choice of healthcare providers, out-of-pocket costs and how bills are paid. Typically, indemnity plans offer a broader selection of healthcare providers than managed care plans. Indemnity plans pay their share of the costs for covered services only after they receive a bill (which means that you may have to pay up front and then obtain reimbursement from your health insurance company).

There are several different types of managed-care health insurance plans. These include HMO, PPO, and POS plans. Managed-care plans typically make use of healthcare provider networks. Healthcare providers within a network agree to perform services for managed-care plan patients at pre-negotiated rates and will usually submit the claim to the insurance company for you. In general, you’ll have less paperwork and lower out-of-pocket costs with a managed care health insurance plan and a broader choice of healthcare providers with an indemnity plan. When selecting a managed care plan it is always wise to review the insurer’s network of providers to ensure the doctors and other providers that you most desire are ‘in’ the network.

An in-network provider is one contracted with the health insurance company to provide services to plan members for specific pre-negotiated rates. An out-of-network provider is one not contracted with the health insurance plan. Typically, if you visit a physician or other provider within the network, the amount you will be responsible for paying will be less than if you go to an out-of-network provider. Though there are some exceptions, in many cases, the insurance company will either pay less or not pay anything for services you receive from out-of-network providers. As a general rule, PPO, POS, and HMO plans make use of provider networks. Indemnity plans typically do not.

WHAT IS A PPO PLAN?

A PPO plan allows you ‘freedom of choice.’ As a member of a PPO (Preferred Provider Organization) plan, you’ll be encouraged to use the insurance company’s network of preferred doctors and hospitals. These healthcare providers have been contracted to provide services to the health insurance plan’s members at a discounted rate. With a PPO plan, services rendered by an out-of-network physician are typically covered at a lower percentage than services rendered by a network physician.

You typically won’t be required to pick a primary care physician but will be able to see doctors and specialists within the network at your own discretion. You will typically have an annual deductible to pay before the insurance company starts covering your medical bills. You may also have a co-payment for certain services or be required to cover a certain percentage of the total charges for your medical bills.

WHAT IS A POS PLAN?

A PPO plan also allows you ‘freedom of choice.’ A POS (Point of Service) plan combines some of the features offered by HMO and PPO plans. As with an HMO, members of a POS plan are required to choose a primary care physician (PCP) from the plan’s network of providers. Services rendered by your PCP are typically not subject to a deductible. Also, like HMOs, POS plans typically offer coverage for preventive care visits.

Typically, however, you will only receive a higher level of coverage for services rendered or referred by your PCP. Services rendered by a non-network provider may be subject to a deductible and will likely be covered at a lower level. If services are rendered outside of the network, you’ll likely have to pay up-front and submit a claim to the insurance company yourself.

WHAT IS AN HMO PLAN?

An HMO plans provides coverage from a network of providers. Though there are many variations, HMO (Health Maintenance Organizations) plans typically enable members to have lower out-of-pocket healthcare expenses but also offer less flexibility in the choice of physicians or hospital than other health insurance plans. As a member of an HMO, with most plans and insurers you’ll be required to choose a primary care physician (PCP). Your PCP will take care of most of your healthcare needs. Before you can see a specialist, you’ll need to obtain a referral from your PCP.

With an HMO you’ll likely have coverage for a broader range of preventive healthcare services than you would through another type of plan. You may not be required to pay a deductible before coverage starts and your co-payments will likely be minimal. With an HMO plan, you typically won’t have to submit any of your own claims to the insurance company. However, keep in mind that you’ll likely have no coverage whatsoever for services rendered by non-network providers or for services rendered without a proper referral from your PCP. You do, however, typically have world-wide coverage for accidents and illness in the event you are traveling and face a medical emergency.

WHAT IS AN INDEMNITY PLAN?

A traditional Indemnity plan offers a great deal of freedom in choosing which doctors and hospitals to use, but will probably involve higher out-of-pocket costs and more paperwork.

Under an Indemnity plan, you may see whatever doctors or specialists you like, with no referrals required. Though you may choose to get the majority of your basic care from a single doctor, your insurance company will not require you to choose a primary care physician.

However, this kind of freedom will cost you. You’ll likely be required to pay an annual deductible before the insurance company begins to pay on your claims. Once your deductible has been met, the insurance company will typically pay your claims at a set percentage of the “usual, customary and reasonable (UCR) rate” for the service. The UCR rate is the amount that healthcare providers in your area typically charge for any given service. An Indemnity plan may also require that you pay up front for services and then submit a claim to the insurance company for reimbursement.

WHAT TYPE OF MEDICAL PLAN IS BEST FOR ME?

Choosing between different health insurance plans isn’t always easy. There is no one “best” plan for everyone. The best match for you and your family may be different than the best match for someone else. The Agents and Client Advocates here at Morris & Reynolds will be happy to help guide you in finding the type of insurer and plan that is best for you. Here are a few initial things to consider when trying to determine what’s best for you and/or your family:

1) Are you going to need long-term coverage or just something for the short-term?

If you’re between jobs for 1-6 months, you may want to look into our short-term coverage options. Alternatively, if you have no prospects of receiving group health insurance coverage through an employer, you may value the stability and increased benefits offered through an individual and family health insurance plan which will provide longer term coverage.

2) Are you looking for basic coverage or more comprehensive coverage?

Some insurance plans offer basic coverage (i.e., primarily inpatient hospitalization and outpatient surgery coverage) to cover you in case of a major accident or illness. These insurance plans typically have a lower monthly premium than plans with more comprehensive coverage, and may be appropriate for people who intend to use their insurance primarily in the event of a serious accident or illness.

Other insurance plans, in addition to offering coverage in case of a major accident or illness, offer more comprehensive coverage which MAY include benefits such as: preventative care, physician services, prescription drug benefits and routine office visits. These insurance plans typically have a higher monthly premium than plans that only offer basic coverage, and may be appropriate for people who intend to use their insurance on a regular basis.

Healthcare Reform’s Patient Protection and Affordable Care Act (PPACA) requires that all plans must provide coverage for certain preventive benefits, immunizations, and screenings*, without cost sharing requirements for plan/policy years beginning on or after September 23, 2010. This rule does not apply to grandfathered plans. (*As recommended by the US Preventive Services Task Force, the CDC, and the Health Resource and Services Administration (HRSA)).

3) Would you rather pay for your services before you use them or when you use them?

Typically, the higher the monthly premium that you pay, the less you will pay per doctor’s visit in co-payments and deductibles. If you choose a health insurance plan with a low monthly premium, you’re likely to have a higher co-payment or deductible. If you don’t anticipate making frequent use of your health insurance coverage, a higher-deductible plan with a lower monthly premium may suit you best.

4) How important to you is easy access to specialists?

Health insurance plans that require you to coordinate your care through a primary care physician typically require that you obtain a referral before seeing a specialist. Thus, if you prefer easier access to specialists, you may wish to consider a different type of plan.

5) Do you have a specific doctor or hospital that you would like to visit for healthcare?

Some insurance plans utilize provider networks. Pay special attention to the network of doctors or facilities that each health insurance plan utilizes. You’ll want to make sure that your favorite doctor or hospital is included on the list for the health insurance plan you choose. Also note that networks utilized by health insurance plans can change, so there is no guarantee that your doctor will always be contracted with your chosen health insurance plan.

6) What is the most you could pay out in case of a serious illness or injury?

Health insurance plans typically place limits on how much a member is required to pay out of pocket per year for his or her healthcare. This limit is often referred to as an out-of-pocket maximum. Once you’ve contributed this maximum amount toward your healthcare, the health insurance company typically covers all other costs for the remainder of the benefit year. In 2014, PPACA will limit out of pocket expenses for essential health benefits* for low income individuals. If you’re concerned about what may happen to you in case of a serious illness or injury, you may wish to pay special attention to the out-of-pocket maximums for the health insurance plans you’re considering.

In addition to offering a wide range of individual medical insurance options, some of the benefits of our employee benefit related work for our clients include;

ALL FORMS OF INSURANCE & EMPLOYEE BENEFITS

• Ancillary (Voluntary/Employee Paid)
• Benchmarking
• Benefits Administration
• Brokerage
• Cancer & Critical Illness
• Communications
• Compliance Consulting
• Consulting
• Dental Insurance
• Disability (Short & Long Term)
• Employee Assistance Plans (EAP)
• Health & Welfare Plans (Group)
• Health / Medical Insurance
• Healthcare Reform
• Hospital Indemnity
• Individual Health
• Life Insurance (Group)
• Payroll Deduction Auto & Home
• Pharmacy Consulting
• Plan Design
• Plan Management
• Pre-Paid Legal Plans
• Network Evaluation
• Retiree Health Care
• Retirement Plans (401k’s)
• Vision Insurance
• Wellness & Productivity

SUPERIOR MARKET KNOWLEDGE, RELATIONSHIPS & INSURER ACCESS

Morris & Reynolds represents and has access to the entire market of leading insurers. Many of our relationships with major insurers span decades and often find us in a leadership position as an advisor or agent Board member.

AGGRESSIVE, TRANSPARENT, NEGOTIATIONS

Your employee benefit’s goals and bottom line are our sole focus. The coverage and costs that we negotiate, in fact all we do, is focused on you and your employees. We are known as aggressive negotiators who have our clients’ best interest at heart. Always.

We also enjoy serving our clients in the most transparent manner possible and are happy to discuss and disclose our compensation and answer your questions about that important topic with you. Morris & Reynolds is a truly independent insurance agency and has been since 1950. Our focus is never on stockholders, stock prices or an insurance company preference but our client’s goals, dreams and desires. Always.

HANDS-ON DAY TO DAY CARE & ADVOCACY FOR YOU & YOUR EMPLOYEES

Let’s face it, insurance can be time consuming and frustrating. Dealing with providers and insurers is often an experience filled with ‘red tape’, delays and frustration. Whether you or your employees have a question about your coverage, a provider, a bill or a claim we are here to help every step of the way. Our Client Advocates are here at Morris & Reynolds everyday focused on assisting you and your employees with provider and claim concerns as well as the never ending ‘red tape’ involved with America’s medical ‘system’.

WELLNESS

An apple a day really can keep the doctor away (along with exercise, an education on health and wellness). Morris & Reynolds is deeply proud of the work we do with many of our employee benefit clients to help make their employees happier, healthier and more productive both personally and professionally.

PEACE OF MIND

Your employees and their satisfaction with the benefits you offer to them is very important to your business and your peace of mind. At Morris & Reynolds Insurance we take your benefits, employees and peace of mind, to heart in all we do from the coverage that we structure, the insurers we suggest and the day to day service and care we provide to our clients and your employees. When you need us most, we will always be there.

VISION & INNOVATION

At Morris & Reynolds Insurance our client’s receive the best of both worlds. We are well known for our ‘old fashioned’, reliable and responsive service that dates to the founding of our agency in 1950. We are also known for employing cutting edge technology and offering the latest in coverage innovations and ideas to serve our client’s ever evolving needs. Services such as The Protection Portal and Morris & Reynolds MyWave are just two examples of our forward thinking approach to service.

AWARD WINNING, EDUCATED, PROFESSIONAL PEOPLE

Our Client Service Underwriters, Client Advocates and Professional Agents are deeply committed to their profession and career-long learning. Our award winning TEAM of professional people, the finest people in employee benefits and insurance, is unique to Morris & Reynolds Insurance. In order to offer our client’s the very finest results possible we constantly seek improvement by way of training, performance measurement and process reviews.

Our corporate office is an approved and certified testing site for the prestigious Insurance Institute of America and their curriculum is part of our ongoing TEAM educational efforts. Morris & Reynolds Insurance is proud of the awards that TEAM members have received from a variety of industry associations and insurers, including the Florida Agent of the Year, The National Agent of the Year and The Customer Service Representative of the Year Honors to name a few.

Trusted Insurance

"Savings & Service Has Been Our Policy Since 1950"
14821 South Dixie Highway, Miami, Florida 33176
P 305.238.1000 | F 305.255.9643
E info@morrisandreynolds.com

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