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Understanding Health Insurance Selection Process

1. DOES YOUR PLAN COVER YOU ON AND OFF THE JOB?

Numerous health insurance plans have specific exclusions that eliminate your benefits for anything that could have been covered under Workers Compensation or similar laws. Now read that last sentence again.

COULD HAVE BEEN covered!?

That is correct. Most self-employed individuals and even some small business owners do not carry Workers Comp on themselves.

There are insurance policy plans that are designed to cover you on and off the job 24 hours a day, if you are not required by law in your state to have Workers Compensation coverage.

2. ARE YOU WRITING IT OFF?

Independent contractors (1099s), home-based business owners, professionals, and other self-employed individuals generally are not taking advantages of the tax laws available to them.

Numerous individuals who are paying 100% of their own costs are able to deduct their monthly insurance policy payments and just don’t know it. This alone can reduce your net out-of-pocket costs of a proper plan by as much as 40%. Ask your accounting professional if you are eligible and/or check out the IRS website for more information.

3. INTERNAL LIMITS

All true insurance plans use some form of internal controls to determine how much they will pay out for a particular procedure or service. There are two fundamental methods.

Scheduled profits

Many plans, some of which are specifically marketed to self-employed and independent individuals, have a clear schedule of what they will pay per doctor office visit, hospital stay, or even limits on what they will pay for testing per 24-hour period. This structure is normally associated with “Indemnity Plans”. If you are presented with one of these plans, be sure to see the schedule of benefits, in writing. It is essential that you understand these types of limits up front because once you reach them the company will not pay anything over that amount.

Usual and Customary

“Usual and Customary” concerns the rate of pay out for a doctor office visit, procedure, or hospital stay that is based on what the majority of physicians and facilities charge for that particular service in that certain geographical or comparable area. “Usual and Customary” charges represent the highest level of coverage on most major medical plans.

4. YOU HAVE THE ABILITY TO SHOP!

If you are reading this, you are plausibly looking into purchasing a health plan. Every day individuals shop for everything from groceries to a new home. During the shopping process, generally, the buyer evaluates all the value, price, personal requirements and general marketplace. With this in mind, it is very disconcerting that most people never ask what a test, procedure, or even doctor visit will cost. In this ever-changing health insurance policy market, it will become increasingly primary for these questions to be asked of our medical professionals. Asking about price will help you get the most out of your plan and reduce your out-of-pocket expenses.

5. NETWORKS AND DISCOUNTS

Almost all insurance plans and benefit programs work with medical networks to access discounted rates. In broad strokes, networks consist of medical professionals and facilities that agree, by contract, to charge discounted rates for services rendered. In Numerous cases the network is one of the defining attributes of your program. Deductions can vary from 10% to 60% or more. Medical network rebates vary, but to secure minimum out-of-pocket expenses, it is imperative that you preview the network’s list of physicians and facilities before committing. This is not only to secure that your local doctors and hospitals are in the network, but also to see what your options would be if you were to need a specialist.

Ask your agent what network you are in, ask if it is local or national and then find out if it meets your own personal claims before you buy!