Health Insurance

health insurance claim form

Health Insurance for Individuals and Families

Health Insurance Seward Insurance is pleased to offer health insurance to families and individuals. Health insurance is a contract between you and the insurer in which you agree to pay premiums in exchange for certain covered medical expenses in which the insurer agrees to pay all or a portion of the costs either as a reimbursement to the insured under traditional health insurance policies, or directly to the provider under health plans such as Preferred Provider Organizations (PPOs), Health Maintenance Organizations (HMOs) and Point Of Service (POS).

With the rising costs of health care, commercial insurers have moved more towards offering health plans rather than health insurance to control costs. Health Plans differ from health insurance in that plans have subscribers rather than policyholders, provide the majority of their benefits on a service basis instead of through reimbursement and have contractual relationships with hospitals and doctors for fixed costs.

Preferred Provider Organizations are a group of independent hospitals and medical practitioners that agree to provide services at a prearranged cost in certain geographical areas such as a state, and are managed by the organizer or contractor of the PPO. In general, PPOs provide more provider choices for its subscribers than an HMO, require a co-payment, allow for self-referral and cover some of the costs for services outside their provider network.

Health Maintenance Organizations are cooperatives that enter into agreements with a variety of health care providers and facilities to provide services for its subscribers with membership restricted to a specifically defined group. HMOs must provide inpatient hospital and physician services, outpatient medical services, preventive health services and in and out of area emergency services. Many HMOs may also provide or offer for purchase supplemental health care services such as prescription drugs, vision care, dental care, home health care, nursing services, long term care or substance abuse services. HMOs may also require nominal co-payments.

Point of Service plans are another form of managed care that allows it subscribers to seek services wherever they choose, but with varying coverage based on whether the services were provide in-network or out-of-network. In-network services have higher coverage benefits and require no claims to be submitted. Out-of-network services have lower coverage benefits and require claims be submitted for services provided.

If  you want to know which health insurance plan best suits you, please contact us at Seward Insurance. We provide fast and efficient service with a personal touch.