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Health-Insurance-Policies

In A Bad Economy, Here Are 5 Basic Facts About Health Insurance Policies

1. IS YOUR PLAN COMPREHENSIVE ENOUGH TO COVER YOU ON AND OFF THE JOB?

Numerous health insurance policies contain specific limitations that eliminate coverage for claims made under Workers Compensation or comparable statutes. Now read the final sentence once more.

PERHAPS IT COULD HAVE BEEN COVERED!?

That is accurate. The majority of self-employed individuals and even some small business owners do not cover Workers Compensation.

There are insurance policies that are designed to cover you both on and off the job – 24 hours a day, if you are not required by law to have Workers Compensation coverage.

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5 Basic Facts About Health Insurance Policies In A Bad Economy

2. ARE YOU NOTIFYING IT?

In general, independent contractors (1099s), home-based business owners, professionals, and other self-employed individuals do not take use of applicable tax rules.

Numerous individuals who pay their own expenses in full are allowed to deduct their monthly insurance premiums. This alone can cut your net out-of-pocket costs associated with a suitable plan by up to 40%. Consult your accounting professional to determine your eligibility and/or visit the IRS website for additional information.

3. INTERNAL RESTRICTIONS

Internal controls are used by all real insurance plans to determine how much they will pay for a certain procedure or service. There are two fundamental techniques.

  • Benefits Scheduled

Numerous plans, some of which are targeted exclusively at self-employed and independent individuals, include a clear schedule of what they will pay per medical office visit, hospital stay, or even per 24-hour period for testing. This structure is frequently used in conjunction with “Indemnity Plans.” If you are offered with one of these plans, insist on seeing the written schedule of benefits. It is critical to recognize these kind of limits up front, as once reached, the corporation will not pay anything more.

  • Traditional and Customary
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“Usual and Customary” refers to the rate charged for a doctor’s office visit, procedure, or hospital stay that is consistent with the rates charged by the majority of physicians and facilities in that geographical or comparable area. The term “Usual and Customary” refers to the highest level of coverage available under the majority of major medical policies.

4. YOU ARE CAPABLE OF SHOPPING!

If you’re reading this, you’re presumably in the market for a health insurance plan. Every day, individuals shop for a variety of items, ranging from groceries to a new home. Generally, the buyer evaluates the value, price, personal needs, and general marketplace during the shopping process. With this in mind, it’s perplexing that the majority of people never inquire about the cost of a test, procedure, or even a doctor visit. In an ever-changing health insurance market, it will become increasingly critical to ask these questions of our physicians. The asking price will assist you in maximizing the value of your plan and minimizing your out-of-pocket expenses.

5. COLLECTIVES AND DISCOUNTS

Almost all insurance plans and benefit programs have negotiated discounted pricing with medical networks. Broadly speaking, networks are made up of medical experts and institutions that have contractually agreed to provide lower prices for services rendered. In many circumstances, the network is one of your program’s defining characteristics. Discounts range from 10% to 60% or more. Discounts vary every medical network, but to guarantee you pay the least amount possible out of pocket, it is critical to study the network’s list of physicians and facilities before committing. This is not only to guarantee that your local doctors and hospitals are included in the network, but also to determine your alternatives in the event of a specialist referral.

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Inquire with your agent about the network you are a part of, whether it is local or national, and then assess whether it matches your specific needs. Health Insurance Policies

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