1. Does your plan cover you on and off the job?
Many health plans have specific exclusions that eliminate your benefits for anything that may have been covered by workers’ compensation legislation or similar legislation. Now, read this last sentence again.
Could it have been covered?
It’s okay. Most self-employed workers and even some small business owners do not use workers’ compensation.
There are insurance plans designed to cover you, whether you are at work or not, 24 hours a day if the law does not require you to have workers’ compensation coverage.
2. Are you writing it off?
Independent contractors (1099), home business owners, professionals, and other self-employed people generally do not enjoy the benefits of the tax legislation available to them.
Many people who pay 100% of their own expenses can deduct their monthly insurance payments. This can only reduce the net costs of an appropriate plan by up to 40%. Ask your accounting professional if you qualify and/or visit the IRS website for more information.
3. Internal limits
All true insurance plans use some type of internal control to determine the amount they will pay for a particular procedure or service. There are two basic methods.
Many plans, some of which are specifically for the self-employed and for the self-employed, have a specific calendar that indicates the amount to be paid per visit to the doctor, for hospitalization, or even a limit of what they will pay for tests. 24 hours. period.
This structure is generally associated with “compensation schemes”. If you are presented with any of these plans, be sure to verify the written benefit program. It is important that you understand these types of limits from the beginning because once you reach them, the company will pay nothing more than that amount.
Usual and customary
“Usual and customary” means the reimbursement rate of a visit to the doctor, procedure, or hospital stay, calculated on the basis of the fees charged by most doctors and institutions for this service. Particularly in this geographical area or in a comparable area. The “usual and usual” rates represent the highest level of coverage covered by most health insurance plans.
4. You have the ability to shop!
If you are reading this, you are probably buying a health plan. Every day, people go shopping, from groceries to the new house. During the purchase process, the buyer generally evaluates the value, the price, the personal needs and the market in general.
In this sense, it is very disconcerting that most people never ask what a test, a procedure or even a visit to the doctor will cost. In this constantly evolving health insurance market, it will be increasingly important to ask these questions to our health professionals. The requested price will help you make the most of your plan and reduce your personal expenses.
5. Networks and discounts
Almost all insurance plans and benefit programs work with medical networks to access discounted rates. In general terms, the networks are formed by health professionals and medical facilities that contractually agree to apply reduced rates to the services provided.
In many cases, the network is one of the attributes that define your program. Discounts can range from 10% to 60% or more.
Reimbursements in the medical network vary, but to minimize your expenses, it is imperative to preview the list of doctors and network centers before committing. It’s not just about making sure your doctors and local hospitals are part of the network, but also what your options would be if you needed a specialist.
Ask your agent what network you are in, ask if it is local or national and determine if it meets your needs.