What is Health Insurance?
Insuring against the disastrous financial loss that can result from an illness or an injury
Those of us who have been ill or injured know how important health insurance really is. As its name implies, health insurance helps insure that we and our families have ready access to health care services when we need them. It also helps insure against the disastrous financial loss that can result from an illness or an injury. But with all the Texas health insurance options out there, how are you to know which one is best? Generally, when people talk about "health insurance," they're referring to the kind of insurance that covers doctor and hospital bills.
Selected Benefits primarily deals with PPO plans for it's Texas health insurance clients. A PPO (Preferred Provider Organization) is a managed healthcare system popular throughout the United States. Similar to its cousin the HMO, Health Maintenance Organization, PPO's provide a high level of healthcare, as well as a variety of medical facilities available to all participants.
Unlike the HMO however, a PPO is actually a group of doctors and hospitals that work under one umbrella (called the PPO), to provide medical services at a discount to the PPO participants. By granting discounts to the participants via an insurance company, the insurance companies are able to entice people to join the PPO by offering financial incentives. These incentives may include: greater discounts for medical services performed by in-system doctors; lower deductibles and lower co-payments.
Also different from the HMO's, PPO participants pay for services when rendered and are reimbursed a percentage of the cost by the healthcare provider at a later time (though many PPO doctors prefer to invoice the healthcare provider directly). The percentage of reimbursement depends on the healthcare policy, a previously established rate agreement, and whether the doctor/hospital is within the PPO network.
Unlike the HMO systems, PPO participants may utilize any doctor they wish, and are not required to select a primary care physician (PCP), and do not require authorization from that PCP before the enrollee seeks medical assistance for any ailment or malady. However, PPO enrollees are urged to select doctors within the PPO system, by way of higher reimbursement and lower co-payments.
Aetna Application
