BASIC FACTS EVERYONE SHOULD KNOW ABOUT HEALTH INSURANCE
Does your plan cover you on and off the job?
Many 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 people and even some small business owners
do not carry workers compensation on themselves.
ABA can design plans that will cover you on and off the job ~ 24-hours
a day, if you are not required by law to have workers compensation coverage.
Are you writing it off?
Independent contractors (1099's), home based business owners, professionals
and other self-employed people generally are not taking advantage of the tax laws available to them.
Many people who are paying 100% of their own costs are eligible to deduct their
monthly insurance payments. Just that 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.
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 basic methods.
Many plans, some of which are specifically marketed to self-employed and independent
people, 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-hr. period. This structure is usually 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 important that you understand these type of
limits up front because once you reach them the company will not pay anything over that amount.
Usual and customary
"Usual and Customary" refers to 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 particular geographical or comparable area. "Usual and Customary" charges represent the highest level of coverage
on most major medical plans. Most plan designs use this method.
YOU HAVE THE ABILITY TO SHOP!
If you are reading this you are probably shopping for a health plan. Every
day people shop, for everything from groceries to a new home. During the shopping process, generally the value, price, personal
needs and general marketplace gets evaluated by the buyer. 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 market, it will become increasingly
important for these questions to be asked of our medical professionals. Asking price will help you get the most out of your
plan and reduce your out-of-pocket expenses.
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 who agree, by contract,
to charge discounted rates for services rendered. In many cases the network is one of the defining attributes of your program.
Discounts can vary from 10% to 60% or more. Medical network discounts vary, but to ensure you minimize your 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 ensure 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 determine if it meets your own individual needs.
Why Design a Plan?