What Is Security Health Plan? Your Guide to Comprehensive Health Coverage

Navigating the world of health insurance can often feel overwhelming, filled with jargon and countless options. You might be asking, "What exactly is Security Health Plan, and could it be the right fit for me?" If you're seeking clarity on a health plan known for its quality and community focus, you've come to the right place.

This comprehensive guide will demystify Security Health Plan, exploring its core offerings, who it serves, and how you can make informed decisions about your healthcare coverage. We'll break down the essentials, helping you understand if this plan aligns with your health and financial needs.

What Exactly Is Security Health Plan?

Security Health Plan of Wisconsin, Inc. is a physician-sponsored, not-for-profit health maintenance organization (HMO) with a deep commitment to its members' well-being. Based in Marshfield, Wisconsin, it operates as a vital part of the Marshfield Clinic Health System. Established in 1986, Security Health Plan has grown to serve over 180,000 members across a 32-county service area in Wisconsin, making it one of the largest health maintenance organizations in the state.

Unlike some national carriers, Security Health Plan's unique physician-led structure means its operations are guided by a commitment to patient care, aiming to keep members' best interests at heart. This dedication to quality has earned it consistent recognition, including top ratings from the National Committee for Quality Assurance (NCQA) and the Centers for Medicare and Medicaid Services (CMS) for its various plans.

Key Features and Benefits of Security Health Plan

Security Health Plan offers a diverse portfolio of insurance and benefit options designed to meet a wide range of healthcare needs. What can you expect when you choose Security Health Plan?

Comprehensive Coverage Options

Security Health Plan provides various types of coverage, ensuring options for individuals, families, and employers. These include:

• Employer Group Products: Offering HMO, EPO, POS, and indemnity plans for businesses of all sizes.
• Individual and Family Policies: Available both directly and through the Health Insurance Marketplace.
• Medicare Advantage Plans: These HMO-POS plans often include Part D prescription drug coverage and may feature $0 premiums, along with extra benefits like dental, hearing, and vision care.
• Medicare Supplement Plans: Designed to complement original Medicare benefits.
• BadgerCare Plus Managed Care: Providing healthcare access for eligible Medicaid beneficiaries in Wisconsin.
• Third-Party Administration (TPA) Services: Through Security Administrative Services, they also offer administrative support for self-funded employer groups.

Robust Network of Providers

As part of the Marshfield Clinic Health System, Security Health Plan members benefit from access to a broad network of affiliated providers, including thousands of specialists, primary care physicians, and non-physician providers across many Wisconsin counties. While it's primarily an HMO, which typically requires members to use in-network providers and sometimes referrals for specialists, Security Health Plan does make provisions for emergency and urgent care outside the network.

Member-Centric Services and "Perks"

Security Health Plan goes beyond basic coverage, offering additional resources aimed at supporting overall health and well-being:

• Wellness Resources: Access to tools and programs to help members achieve their health goals.
• 24-Hour Nurseline (Care My Way®): Direct access to nurse practitioners for common health concerns, even offering prescription services when appropriate.
• Health Coaching & Preventive Care: Programs for smoking cessation, health coaching, and convenient at-home screenings for conditions like colorectal cancer.
• Cost-Saving Benefits: Allowances toward over-the-counter items, hearing aids, eyeglasses, and significant cost savings on insulin.
• Exceptional Customer Service: Known for clear benefit statements, accurate and on-time claims payments, and friendly, knowledgeable customer service.

Who Can Benefit from Security Health Plan?

Security Health Plan serves a diverse population within its Wisconsin service area. Could you be among them?

• Individuals and Families: If you're looking for comprehensive health insurance coverage for yourself or your loved ones, Security Health Plan offers various individual and family plans, including those available on the Health Insurance Marketplace.
• Seniors and Medicare Beneficiaries: For those 65 or older, or individuals with certain disabilities, Security Health Plan provides highly-rated Medicare Advantage and Medicare Supplement plans that often include additional benefits not covered by Original Medicare.
• Low-Income Individuals and Families: Through the BadgerCare Plus Managed Care program, Security Health Plan offers affordable HMO plans to those who qualify for Medicaid in Wisconsin.
• Employers: Businesses of all sizes can find tailored health insurance solutions for their employees, with options ranging from traditional HMOs to more flexible POS and indemnity plans.
• Self-Funded Groups: Companies that self-fund their employee health benefits can utilize Security Health Plan's administrative services, leveraging their medical management expertise.

How to Choose the Right Security Health Plan for You

Selecting a health plan is a significant decision. Here's a step-by-step approach to help you determine the best Security Health Plan option for your needs:

1. Assess Your Healthcare Needs:

   • Do you have preferred doctors or specialists? Check if they are in the Security Health Plan network.
   • Consider your typical healthcare usage: do you visit the doctor frequently, or do you mostly need preventive care?
   • Factor in any ongoing prescriptions or chronic conditions, as plans vary in drug coverage and disease management programs.

2. Understand Plan Types:

   • HMO (Health Maintenance Organization): Most Security Health Plan offerings are HMOs, which typically require you to choose a primary care provider (PCP) within the network and get referrals for specialists.
   • PPO (Preferred Provider Organization) & EPO (Exclusive Provider Organization): While Security Health Plan is primarily an HMO, they do offer some EPO and POS (Point-of-Service) options, particularly for employer groups, which might offer more flexibility for out-of-network care, albeit at a higher cost.

3. Compare Costs:

   • Premiums: This is your regular monthly payment for coverage.
   • Deductibles: The amount you pay out-of-pocket before your insurance starts covering costs. Some plans may cover basic services before the deductible is met.
   • Copayments (Copays): Fixed amounts you pay for specific services, like doctor visits or prescriptions.
   • Coinsurance: A percentage of the cost of a service you pay after your deductible is met.
   • Out-of-Pocket Maximum: The most you will pay for covered services in a plan year. Once you hit this, the plan pays 100% of covered costs.

4. Review Additional Benefits and "Perks":

   • Do the wellness programs, nurse line, or other extra benefits align with your lifestyle and health goals?
   • Consider dental, vision, and hearing benefits, especially with Medicare Advantage plans.

Enrollment Process: A Step-by-Step Guide

Once you've identified a Security Health Plan that fits your needs, the enrollment process is straightforward:

1. Determine Your Enrollment Period:

   • Open Enrollment: For individual and family plans, this typically occurs annually. For Medicare, the Annual Enrollment Period (AEP) is from October 15 through December 7.
   • Special Enrollment Period (SEP): You may qualify for an SEP if you experience certain life events like marriage, birth of a child, loss of other coverage, or moving.

2. Gather Necessary Information:

   • You'll generally need personal identification, Social Security numbers, and income information to apply.

3. Choose Your Application Method:

   • Online: You can often apply directly through the Security Health Plan website or through health insurance marketplaces like eHealth or HealthSherpa.
   • In-Person: Security Health Plan has "Answer Centers" located at Marshfield Clinic locations where local agents can provide expert advice and help with enrollment.
   • By Phone: You can also call their customer service or a licensed insurance agent for assistance.

4. Confirm Your Enrollment: After applying, you'll receive confirmation and plan documents. Review these carefully to understand your coverage start date and specific benefits.

Maximizing Your Security Health Plan Benefits

To get the most out of your Security Health Plan, consider these actionable tips:

• Understand Your Plan Documents: Read your Summary of Benefits and Coverage (SBC) and Evidence of Coverage (EOC) to know what's covered, what requires referrals or prior authorization, and your cost-sharing responsibilities.
• Utilize Preventive Care: Take advantage of covered preventive screenings, vaccinations, and annual check-ups. These services are often covered at 100% and are crucial for maintaining long-term health.
• Engage with Wellness Programs: Participate in health coaching, smoking cessation programs, and fitness resources offered by Security Health Plan to support your well-being.
• Contact Member Services: If you have questions about coverage, claims, or finding a provider, don't hesitate to call their customer service. They are there to help.
• Use Online Portals: Many health plans offer online member portals where you can view claims, manage your account, and access resources.

Conclusion

Security Health Plan stands out as a high-quality, physician-sponsored health maintenance organization deeply rooted in Wisconsin communities. With its comprehensive range of plans, focus on member well-being, and strong ratings from national quality organizations, it offers a compelling option for individuals, families, seniors, and employers alike. Understanding "What is Security Health Plan" means recognizing its commitment to providing accessible, quality healthcare tailored to diverse needs.

Are you a current Security Health Plan member? What has your experience been like? Share your thoughts in the comments below! Or, if you're exploring health insurance options, consider visiting the official Security Health Plan website or contacting a local agent to learn more about plans available in your area.

Frequently Asked Questions

Is Security Health Plan available nationwide?

No, Security Health Plan of Wisconsin, Inc. primarily serves a specific service area within Wisconsin, covering over 32 counties for most plans and expanding to 54 counties for Medicare Advantage plans.

How do I find a doctor in the Security Health Plan network?

You can typically find a provider directory on the Security Health Plan official website. You can also contact their customer service line for assistance in finding an in-network doctor or confirming if your current doctor is covered.

What is the difference between an HMO and PPO with Security Health Plan?

Security Health Plan is primarily an HMO (Health Maintenance Organization), which means you generally choose a primary care provider (PCP) within their network and often need referrals to see specialists. While they offer some EPO (Exclusive Provider Organization) and POS (Point-of-Service) plans, particularly for employer groups, these may offer more flexibility for out-of-network care, usually at a higher cost.

Can I change my Security Health Plan after enrolling?

Generally, you can only change your health plan during specific enrollment periods, such as the annual Open Enrollment Period for individual plans or the Annual Enrollment Period for Medicare. However, certain qualifying life events may allow you to make changes during a Special Enrollment Period. It's best to contact Security Health Plan directly or consult their official resources for specific rules regarding plan changes.