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.


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.


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.


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.


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.


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.


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As an independent agency, not some insurance company, we offer choices from all of the leading insurers and act as your advocate and navigator through the complex world of insurance.

Morris & Reynolds represents and access 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. We also offer immediate access to America’s Health Insurance Exchange along with the professional advice and guidance needed to navigate the many insurer options in addition to providing the day to day service you need in the years to come that we’ve been known for since 1950.


Insurance rates are filed with and regulated by the State Department of Insurance. Whether you buy from Morris & Reynolds, some on line or toll free business you’ll never see, or even directly from an insurance company, you’ll pay the same premium for the coverage you purchase. This means that you can enjoy the advantages and convenience of shopping and purchasing your insurance from Morris & Reynolds’ professional people, as well as have our live, local, service available whenever you need it and rest assured that you’re getting the best available price.


Your coverage and budget goals are our sole focus. The coverage and costs that we quote, in fact all we do, is focused on you and your family. We are known as aggressive negotiators who have our client’s 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.


Let’s face it, insurance can be time consuming and frustrating. Dealing with medical providers, claims paperwork and insurers is often an experience filled with ‘red tape’, delays and frustration. Whether you or your family members 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 family with provider and claim concerns as well as the never ending ‘red tape’ involved with America’s medical ‘system’.


Your satisfaction with the insurance that we provide to you and your family is very important to us. At Morris & Reynolds Insurance we take your 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 you. When you need us most, we will always be there.


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.

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.

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