Facts to Consider Now

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 Compenation 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 Comp on themselves. They could, we all could... if we had an extra arm and leg to pay for that too.

The reality is that most self employed people DO NOT carry Workers Comp and most plans won't pay for medical expenses incurred on the job.

Affordable Insurance Plans can design plans that will cover you on and off the job.

Are you writing it off?

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 paying 100% of their own costs are eligible to write off 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.

Internal Limits

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 independant people have a clear schedule of what they will pay per doctor office visit, hospital stay, or even limits they will pay for testing per 24 hour 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 hit them the company will not pay anything over that amount, leaving you responsible for 100% of remaining costs!

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 area.

Usual and Customary is recognized by the American Medical Association, as opposed to being determined by the insurance company. Usual and Customary charges are the most liberal of standards and represents the highest level of coverage.

Affordable Insurance Plans recommends this method for most of our plan designs.

You have the ability to shop!

If you are reading this you are probably shopping for a health plan. Everyday people shop for everything from groceries to a new home. During the shopping process, generally, the value, price, personal needs and general marketplace are 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 the price up front will help you get the most out of your plan and reduce your out of pocket expenses.

For example, several of our carriers, works with an organization called "LabOne". "LabOne" is an extra feature that in many cases can save you considerable out of pocket costs if you use them. At "LabOne" your insurance company has negotiated additional discounts with a national labratory that can collect and process tests at a fraction of even the network negotiated prices.

Please refer to the Medical Networks section on the left, click on 'LabOne' and see what they can do for you.

Networks and Discounts

All insurance plans and benefit programs work with networks and discounts. 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. Generally, each medical professional and facility has a unique contract with the network, therefore there are wide variances in the discounts that are given. The only way to really find out the pricing structure for a hospital or doctor is to ask their respective billing department.

When shopping for a plan it is imperitive that you preview the network's membership 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, if it is local or national and then determine if it meets your own individual needs.

Affordable Insurance Plans allows you, in most cases, to choose a network that is right for you. We have listed many of our Networks in our Medical Networks section.

For a confidential interview with Dan Arneson, please call Dan at

303-921-0710 or send an email to
darneson@customizeyourinsurance.com

Customize Your Insurance
5893 Booth Dr, | Firestone, CO 80504
Phone 303-921-0710
Fax 303-776-0921

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