Self  Insurance

OK, where do we start?

Well, how about the major types of health insurance:

Major Medical - most comprehensive, and usually the most costly, typically $2-5 million lifetime benefits.  May include options for doctor visits and prescriptions, life insurance, etc. Health conditions may raise rates or trigger a "decline" of coverage.

Mini Medical -  a.k.a. "defined benefit" or "limited benefit" plan.  Upper limits placed on annual, daily , or per incident benefits.  Good coverage for many that are declined by major medical carriers, such as diabetics, heart patients, or those of us that a are height challenged (just a little short for our weight).

Hospital/Surgical - Designed to only cover expenses when confined to a hospital. 

Supplemental Benefits -  Broad category of plans designed to fill gaps in coverage, such as high deductibles, or dental, disability, cancer or critical illness benefits.  Usually pays in addition to other medical policies.

Medical Discount Plans - From our experience, empty promises of major discounts, with no real benefits.  Monthly rates are low, compared to real insurance, and non-refundable application fee is very high.  Hint: Not offered by Self Insurance

Health Savings Account (HSA) -  Excellent option for some people that are OK with paying the initial costs of treatment, with a 100% safety net after the deductible is met.  Also features big tax advantages for those who can benefit from extra deductions.  Self Insurance does offer HSA plans. 

Costs to consider:

Monthly Premium - Paid every month, whether sick as a dog, or fit as a fiddle.  The higher the premium, the less you pay when you get sick or injured, and vice versa.   Buy all of the protection you can afford, but be sure the premium fits your budget.

Deductible - Amount that you pay (100%)-when something happens-before the insurance company starts paying a portion of the expenses.  Note that if you are totally healthy, this amount is never paid.

Co-Insurance - Your share of expenses after the deductible amount is reached.  For example, with am 80/20 plan, you pay 20% on charges that exceed the deductible.  CAUTION: Math ahead....

 With a $5,000 bill, on an 80/20 plan with a $1000 deductible, you would pay $1,800 ($1000 + 20% of the remaining $4000).

Out-of-Pocket Limit - Maximum amount of co-insurance that  you are required to pay before the company covers 100% of cost (limits your risk).  Basic feature of major medical plan, but not generally included in other policies.

Co-pays - Limits on charges for certain services, such as a doctor visits or prescriptions.  This benefit occurs before the deductible has been met.

 Important questions to ask:

• Is this a discount plan or real insurance?

• Can you email the quote and plan details, or send me to a comprehensive web site?
  

• What is the application fee? (if more than $30 or so, they expect you to cancel the policy  -  and they keep the fee.)

• What doctors and hospitals can I use?

• Is deductible annual, or per incident?

• What is the total annual out-of-pocket limit? (a $500 deductible may have a $5,000 OOP)

• Is this price good for "today only"? (beware!)

• What is your name (the agent) and direct phone number, and where are you calling from?