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5 Basic Facts In Relation To Health Insurance Policies In A Poor Economy


1. DOES YOUR PLAN COVER YOU ON AND OFF THE JOB?

Many health insurance policies have specific exclusions that eliminate your benefits for anything that might have been covered under Workers Compensation or similar legislation. Now read that last sentence again.

COULD HAVE BEEN COVERED!?

That is correct. Many 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 mandated by legislation to have Workers Compensation coverage.

2. ARE YOU WRITING IT OFF?

Freelance 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 premiums are eligible to deduct their monthly insurance premiums. Just that alone can reduce your net out-of-pocket costs of a proper plan by as much as 40%. Ask your accountant if you meet the requirements and/or check out the IRS website for more details.

3. INTERNAL LIMITS

All true health insurance policies 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 policies, some of which are chiefly marketed to self employed and independent people, have a clear schedule of how much they will pay per doctor office visit, hospital stay, or even limits on what they will pay for testing per 24-hr. period. This system is usually associated with "Indemnity Plans". If you are shown one of these plans, be sure to see the schedule of benefits, in writing. It is essential that you understand these type of limits up front because once you reach them the company will not pay anything above that amount.

-Usual and Customary

"Usual and Customary" relates to the rate of pay out for a doctor office visit, procedure or hospital stay that is based on what the majority of doctors 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 health insurance policies.

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