As a businessman or would-be-entrepreneur, you face great challenges and take significant financial risks. Your health and medical care, however, is one department where you wouldn’t want to gamble. As a responsible manager, you should scope out the health insurance options available for small business owners like you.
Recently, managed care providers have been accommodating “Groups of One,” meaning you can buy a policy for yourself with premiums comparable to group insurance rates. The greatest plus of group health insurance policies is “guaranteed issue,” meaning they can’t exclude a person due to health problems.
You can also check if there are trade associations or chambers of commerce in your area that may offer membership coupled with health insurance.
If you wish to, get a plan to include your employees. Being an attractive benefit for prospective employees, a group health insurance plan can get you the best workers. In addition there are special tax deductions for businesses that offer health insurance.
To purchase the insurance plan that suits you best, you need to familiarize yourself with the basic types of managed care providers in the market:
Health Maintenance Organizations
Health Maintenance Organizations (HMOs) give you a range of health services for a set monthly fee. You pick your choice of a primary care physician from their list of affiliated doctors. With HMOs, you will not receive coverage if you go beyond their network, except for emergency cases. Most of the time, you become eligible for insurance benefits without a minimum payment (deductible), but you may be required a small copay per office visit and a steady monthly premium.
Preferred Provider Organization
The Preferred Provider Organization (PPO) is another type of care provider that extends health care through an approved group of providers, or through other providers outside the network. Usually, you have to pay a small copay and satisfy a deductible before benefits are paid. It’s less expensive to visit one of the providers in the network. You may seek out-of-network health care services, but your share of the bill will be higher.
Point of Service Plans
Similar to HMOs, your primary physician attends to you and refers to other in-network doctors in Point of Service (POS) plans. You may choose to see an out-of-network doctor and the plan will pay a predetermined amount of the bill; you will shoulder the bigger amount. These plans usually cost more, but your choice of attending physician is not restricted.
Health Savings Accounts
Health Savings Accounts (HSAs) are not part of managed care. It is a relatively new way to pay for health services. Savings accounts have tax incentives and can be accessed whenever the need for health care funding arises. Any surplus in the account earns tax-free interest.
Bottom-line, your own business is your source of income. You are its most valuable player and asset. Take care of your health and ensure your business’ smooth sail. Study your health insurance options and make the right choice.
By: Charles Crawley
Posts Tagged ‘Care Physician’
Texas Health Insurance Basics
February 11th, 2010
Health insurance. Everyone needs it, but not everyone has it. And with medical expenses on a seemingly endless rise, paying out-of-pocket for them could land you in the poor house. So when choosing a health insurance plan, it’s good to know the basics to help you make better, more financially sound choices when selecting a plan.
Health insurance plans generally fall into one of three categories: indemnity plans, also known as reimbursement plans, preferred provider plans (PPOs), and managed care plans (HMOs).
An indemnity plan allows you to choose your own doctors and it completely pays for your medical expenses, either in full or according to a schedule of benefits. The schedule of benefits may be substantially less than your actual costs. Preferred provider plans and managed care plans can provide broader coverage, but they involve an arrangement between the insurer and a specified network of health-care providers. In addition, managed care plans require pre-approval of many health care services. For example, an HMO may require that a primary care physician in its network coordinate all of your care as well as refer you to specialists that belong exclusively to the network.
No matter which kind of health insurance you buy, make sure it provides you with the right kinds of coverage. And when it comes to coverage, a good health insurance plan should offer several types. For example, hospital expense insurance pays room and board as well as incidental services costs if you’re hospitalized. A surgical expense insurance covers surgeons’ fees and all other related costs. A physicians’ expense insurance policy pays for visits to a doctor’s office or when a doctor’s visits you in the hospital. Finally, major medical insurance offers very broad coverage with an extremely high maximum benefit that’s designed to protect you against losses due to serious illness or injury.
So what might be covered in a health insurance plan? When comparing plans, make sure they provide additional benefits that you may need, including:
o Prescription drugs
o Preventive care
o Mental health benefits
o Maternity care
o Vision care
And what can all this cost? In addition to the monthly premium expense, there may be other out-of-pocket expenses that can really add up, especially if you have children or other family members who make frequent visits a doctor. You should check to see if the health insurance plan you’re considering asks you to pay any or all of the following:
o Co-payment — The amount paid for each visit to a health insurance provider. This is generally required by HMOs.
o Deductible —The amount paid toward your medical expenses, most probably annually, before the insurance company pays any claims. This is generally required by indemnity plans.
o Coinsurance — The percentage of your medical costs paid after reaching any applied deductibles.
Now that you’ve established the why and what of health insurance, you need to find out where you can get it. Health insurance can be acquired through a group plan at work or through a group affiliation, such as a school, a club, association, etc. Or you can purchase an individual plan. When buying an individual health insurance plan, you can most probably customize it for your particular needs. If you’re looking for an individual plan, start by going online to compare coverages and rates from a number of companies to find the best plan and rate that meets your needs.
You now know the what’s, why’s and where’s of the health insurance game. Your next step is to select the best health insurance plan that meets your needs. You should select one that gives you the greatest flexibility and the best benefits for the lowest cost. Since this is a major purchase, you should shop around and get several quotes before choosing a plan. But before you dive in, here are a few things to consider:
1. Co-pays, deductibles, and coinsurance requirements, which ones apply?
2. Do you have the freedom to choose your own health-care providers?
3. Does the plan you’re considering cover the health services you need?
4. Does the plan you’re considering work with the health-care providers you’re currently using?
5. Does the plan you’re considering offer family, and individual, coverage?
6. Does the plan you’re considering cover pre-existing conditions? If so, is there a waiting period? FYI — The average waiting period can be three months to one year.
7. Does the insurance company you’re considering have a good reputation and a positive rating from a major ratings organization? For more information, contact your state’s department of insurance.
If you’re interested in premium individual health insurance preferred provider plan at affordable rates, created specifically for young, healthy individuals, you should take a look at Precedent. Visit us at our website, [http://www.precedent.com], for more information. We offer a unique and innovative suite of individual health insurance solutions, including highly competitive HSA-eligible plans, and an unparalleled “real time” application and acceptance experience.
By: Patt Carpenter
Health Insurance 101 Explained
February 2nd, 2010
We all understand the importance of health insurance; however, as the types of health insurance continue to increase it is becoming more and more difficult to select the type of coverage that is best for you and your family. To help you find out which type of policy might benefit you the most, let’s take a look at the most common types of policies.
There is usually a lot of hype regarding HMOs so let’s look at that one first. A HMO is a health maintenance organization plan that works with a specified group of doctors and hospitals within the network. A primary healthcare physician is selected and you must obtain referrals for care that cannot be provided by that physician. The benefits of this type of plan are lower office visit costs and prescription drug co-pays. In addition, there will typically be either no or limited deductible costs for hospital stays. Depending on your coverage, there may also be no pre-existing condition cause limitations. It is also important to understand that your choice of doctors and hospitals will be limited with a HMO and you won’t be able to have out of network services covered.
A PPO or Preferred Provider Organization works similar to a HMO; however, the major difference is that you are not required to select a primary care physician. In addition to the benefit of being free to choose your own physician without worrying about a referral you also gain the benefit of limited or no deductible costs for hospital stays as well as a possible larger selection of physicians that might be available with a HMO. Out of network services may also be covered; however, for a higher charge than in network services.
A POS, or Point of Service, is also similar to a HMO in that you select a primary care physician. The difference is that you are free to choose out of network treatment if you’re willing to pay a higher out of pocket cost.
Another option is what is known as a traditional coverage policy. This type of policy will have a higher monthly premium as well as deductibles. In addition, you will generally be required to pay for services out of your own pocket up front and then submit claim reimbursement forms.
You may also wish to consider various types of disability plans, which cover a percentage of your income in the event that you experience an illness or accident that prevents you from working for a period of time. A short term disability plan will provide benefits from the first day of an accident or the eighth day of an illness up to 26 weeks. Generally, this type of plan will cover 66% of your weekly income.
Long term disability will begin after short term coverage has expired and will provide coverage for a variable term, depending on the policy you select. Some policies are limited to providing coverage up to two years while others will cover you up to the age of 65.
By: Joseph Kenny
