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5 Facts You Need To Know About Health Insurance Policies

By Edited Nov 13, 2013 0 0

There are many health insurance plans that have quite specific exceptions. These exclusions cut out your benefits that are covered in Workers Compensation or other likewise laws. You must understand these often unnoticed facts about health insurance policies.

1. Is your plan covering you on and off your job?
Most self-employed individuals and certain small business owners do not give Workers Compensation to themselves.

If you aren't required by law to be covered by Workers Compensation, then there are insurance plans that can and will cover you both on and off the job.

2. Don't write yourself off.
Home-based company owners, independent contractors and others who are self-employed usually do not take advantage of the tax laws that are available.

If you pay 100% of your own costs, you may be eligible for a deduction in monthly insurance payments. This alone can lower net costs in a proper insurance plan by up to 40%. Consult your accounting professional if you can have this plan and visit the official IRS website for additional information.

3. Internal Limitations
Any true insurance plan will use some kind of internal control to gauge the amount of pay for a specific service or procedure.

~Scheduled Benefits

Many insurance plans, some specifically marketed to those who are self-employed, have a tight schedule of what they will shell out per hospital stay, doctor visit, or limitations on what they'll pay for testing in a 24 hour period. This kind of structure is often linked with "Indemnity Plans". If you are shown one of these type of plans, make sure to see the benefits IN WRITING. It is crucial to understand these limitations; once you arrive at them, the insurance company won't pay a dime over that amount.

~"Usual and Customary"

This term denotes the paying rate for any health care procedure that is based on what most physicians and facilities charge for a particular service. Price will vary according to the comparable area as well as that specific geographical location. "Usual and Customary" charges represent the zenith of coverage on large-scale medical plans.

4. Shop around.
In the shopping process, the price, value, personal desires and the general marketplace gets a stern evaluation from buyers. Therefore, it is quite disturbing that the average person will never ask what a procedure, test or common doctor visit will cost them.

The health insurance market is constantly changing, and will become increasingly significant for questions to be asked for medical professionals. By asking for prices, you will extract the most from your insurance plan and lower any out-of-pocket costs.

5. Networks and their discounts.
The overwhelming majority of health insurance plans and health benefit programs coordinate with medical networks. They do this to gain access to discounted insurance rates.

In general, networks are made of medical professionals and facilities that, by contractual agreement, charge discounted insurance rates for services. These discounts can easily range from 10% to 60% and beyond.

To ensure minimal out-of-pocket costs, preview the network's database of listed facilities and physicians before you commit. This will make sure that your network includes local doctors and hospitals. As well, it allows you to view your options if you required some sort of health care specialist.

The bottom line is, you have to start asking around. Ask your agent what type of network you are in. Question if your network is local or national, and discern from there if your own personal needs are met.


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