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Facts About Health Insurance Policies In Poor Economy

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  • IDEAS Facts About Health Insurance Policies In Poor Economy


    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.


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

    There are designed insurance 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.


    Independent contractors (1099's), home based business owners, professionals and other self employed people generally are not taking advantages 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.

    -Scheduled Benefits

    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.


    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.


    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.

  • #2
    Hi Thanks for sharing a informative post. The information that you have share on facts of health insurance policies in the poor economy. There are different types of health insurance plans that are designed to meet different needs. Some types of plans that restrict your provider choices or encourage you to get care from the plans network of doctors, hospitals, pharmacies, and other medical service providers.
    Traditional indemnity Plans: Until 30 years ago, most people had traditional indemnity coverage. These days, it's often known as fee-for-service.Indemnity plans are a bit like auto insurance. And you pay a certain amount of your medical expenses up front in the form of a deductible and afterward the insurance company pays the majority of the bill.
    Fee For Service: in this type of health coverage, you have complete autonomy that when it comes to choosing doctors, hospitals and other health care providers. You can refer yourself to any specialist without getting permission and the insurance.Under the fee for service plans, insurers will usually only pays for reasonable and customer medical expenses, taking into account what other practitioners in the area charge for similar services.
    Manages care:As it grew, it evolved, leaving us with three basic types of managed care plans. All managed care plans that involves an arrangement between the insurer and a selected network of health care providers, and they offer policyholders.



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