Have Questions About Health Benefit Insurance? Let Us Clear Up These 4 Common Misconceptions

Health benefit insurance plans, also known as limited benefit medical plans, indemnity plans, and fixed cash plans, are plans that provide a fixed benefit payment for covered services. They can offer a range of benefits to help meet you or your family’s needs. But do you have all the right information about this type of coverage before you enroll?

Familiarizing yourself with this type of coverage as a viable option may be a good idea for you and your loved ones, especially in the face of skyrocketing healthcare costs. It can help supplement your major medical coverage and can provide you access to options that may bring you the benefits and features you’ve been looking for.

Take a look below as we debunk common misconceptions about this level of coverage.

Misconception #1: Health benefit insurance plans work the same way as major medical or short-term medical insurance.

Health benefit insurance plans have some important differences from major medical policies. Understanding those differences will help you decide if this type of coverage is right for you.

These plans pay fixed indemnity benefits towards covered procedures as well as offer discounted rates for using in-network providers. There are no deductibles or copays with health benefit insurance plans, and they can provide another layer of financial protection if you need to supplement your major medical coverage. They are not a replacement for major medical insurance. Policies do have limitations, restrictions, and exclusions to consider.

This coverage provides the most benefit to those who are proactive about using in-network providers and taking advantage of the services and features provided. It can also offer guaranteed acceptance.

Misconception #2: Health benefit insurance plans don’t provide quality benefits and have a small network of doctors.

Health benefit insurance plans can often have lower premiums than major medical insurance since they are not providing comprehensive coverage. But they can also provide a host of valuable benefits to help you and your family with medical needs.

The core benefits of a limited benefit medical insurance plan can include fixed benefit payments for the following services:

  • Hospitalization*
  • Emergency care*
  • Doctor’s visits
  • Surgery*
  • Diagnostics and labs
  • Wellness care

*Typically not covered for pre-existing conditions

Fixed benefit health insurance plans can also come with a wide network of doctors nationwide. If the doctor you choose does not accept the insurance, you can pay upfront and submit your own claims for reimbursement, but you may be subject to higher out-of-pocket costs.

They may also provide supplementary non-insurance benefits to serve your needs in other areas of healthcare.

These may include:

  • Prescription savings program on generic and brand-name medications
  • Ability to speak to a licensed doctor over the phone or mobile app to diagnose common illnesses
  • Patient advocacy service that can help you find procedures for the lowest cost and can negotiate medical bills

These benefits combine to create coverage designed to help you and your family with high medical costs or to supplement other insurance. When considering health benefit insurance plans, make sure to learn about all the features that can help you manage healthcare costs and save time.

Keep in mind that there are often exclusions with health benefit insurance plans that are important to look into before choosing a policy.

Exclusions may include:

  • Pre-existing conditions (12-month waiting period)
  • Prescription benefits
  • Maternity benefits

If you have decided on this type of coverage, we provide access to key information to help make the most of your benefits. Your Member Portal access is secure, and you can access it anytime with the username and password sent in your welcome email. The portal will provide you access to a range of information such as your ID cards, claims status, and contact information for your carrier, claims administrator, and MyBenefitsKeeper.

Misconception #3: Health benefit insurance plans are only beneficial for young people or as supplementary insurance.

Health benefit insurance plans can be beneficial for people of all ages with varying medical needs.

While these plans are designed to be supplementary to major medical policies, you can use them in a variety of circumstances.

This type of coverage may fit the needs of those who:

  • Are priced out of major medical coverage, but seek a limited level of coverage for basic needs
  • Want additional benefits to help cover deductibles and copays of a major medical policy
  • Are seeking limited coverage until they are eligible for a major medical policy during Open Enrollment or through their employer

Making the decision about whether health benefit insurance coverage is right for you can be challenging, so talk to your agent about the specific benefits, conditions, and exclusions of any policies.

Note: Health benefit insurance plans are not intended to be a replacement or alternative to ACA or other major medical plans nor does it provide the minimum essential health benefits that are required, and it won’t help to avoid the fee for not carrying health insurance. These plans can have exclusions and limitations, which may not make them a valid option for some.

Misconception #4: Health benefit insurance plans can satisfy ACA requirements.

Fixed benefit insurance plans do not meet the minimum essential coverage required under the Affordable Care Act, so you would likely be subject to a tax penalty. Because they do not have to follow the guidelines for the ACA, premiums tend to be lower as more limited and/or restricted benefits are being offered. Still, these plans can be useful solutions for some who may need to supplement a high-deductible plan or who may otherwise go uninsured.

 

With our leading edge tools and technologies, we’re upgrading how you experience your choice of coverage.

Stay tuned to our next blog post!

Click here to join our Facebook community for more information about your health and your healthcare coverage.

 

Source:

“The Rising Cost of Health Care by Year and Its Causes.” The Balance. https://www.thebalance.com/causes-of-rising-healthcare-costs-4064878

 

If You’re a College Student or Recent Grad, These Healthcare Solutions Got You Covered

Summer has settled in across the country, and we’ve all got something to celebrate in this warm weather. As a college student or recent grad, you certainly have your fair share of reasons and opportunities to celebrate as well. But according to a recent poll, 72% of those in your shoes – or in your caps and gowns as the case may be – are facing a challenge: finding affordable health insurance.

With 40% of your fellow college students and recent grads mostly concerned about the cost of premiums and 20% concerned about high out-of-pocket costs, you will undoubtedly have questions about your options this summer. You may be coming off coverage through your university or your parents’ health plan or you may be waiting for coverage sponsored by your new employers to begin. You may also be priced out of traditional major medical coverage as well. Short-term medical plans may help you address your healthcare needs.

STM plans can include benefits and features such as:

  • Flexibility in length of coverage  in cost depending on benefits selected
  • Variety of deductible and coinsurance options
  • Benefits that are paid in a similar manner to traditional major medical plans
  • Wellness options
  • Little to no waiting periods
  • Next day coverage for some carriers
  • Relatively inexpensive premiums due to lower and more restricted benefits
  • Low-cost doctor and specialist copays depending on the plan selected
  • Open network of physicians, specialists, and hospital depending on the plan selected

Your family may also have concerns about your coverage options as well. When you research your options, talk with them about what STM plans can offer. This level of coverage is available at any time in the year and you can cancel it at any time as well. It can also offer access to providers of your choice, including providers you visited through their parents’ health coverage. If you’re looking to change providers, STM plans can provide you the opportunity to file your own claim and submit for reimbursement if needed.

However, STM coverage does not provide the minimum essential health benefits required by the Affordable Care Act (ACA) and will not help you avoid the penalty for not carrying health insurance. At this time, STM plans have a maximum duration of 3 months at which point you must re-apply to continue coverage. There may be limits on how many times you can re-apply as well. In addition, pre-existing conditions are not covered. Benefits vary by plan and state and may not include those that are listed above. Before making a purchasing decision, review any plan details carefully.

If you find that you aren’t eligible for STM coverage and that you’re priced out of ACA coverage, you may find health benefit insurance plans (commonly known as limited benefit medical plans) to fit your lifestyle and healthcare needs.

Health benefit insurance plans provide a basic insurance coverage that is capped at specific amounts for services provided due to accidental injuries, sickness, inpatient surgical care, outpatient care, and even pre-existing conditions. Plans vary as to the specific, fixed amounts provided and which specific medical services they will provide benefits for, but often times, this level of coverage may provide little to no waiting periods and benefits for critical illness and/or accidental death.

HBI coverage can also offer benefits and features such as:

  • Guaranteed issue coverage
  • Next day coverage or little to no waiting periods for accidental injuries or sickness
  • 12 month waiting period for pre-existing conditions
  • Ability to supplement existing coverage
  • Access to non-insurance benefits such as a prescription savings program, 24/7/365 video and phone access to quality physicians, and a patient advocacy service

But remember: like STM plans, HBI plans do not count as minimum essential coverage required by the Affordable Care Act and is not suitable to serve as your only medical coverage. Although the premiums may be lower than a major medical plan, the benefits are also lower and more restricted.

Benefits offered vary by plan and state. Not available in all states. Make sure to review any plan details carefully prior to making a purchasing decision.

 

With our leading edge tools and technologies, we’re upgrading how you experience your choice of coverage.

Stay tuned to our next blog post!

Click here to join our Facebook community for more information about your health and your healthcare coverage.

man and woman hiking with backpacks

5 Ways to Build Your Summer Body Confidence

The skies are clear and blue, the temperatures are on the rise, and outdoor activities are calling your name. There’s no doubt that summer has arrived, and it’s likely that you’re thinking about your fitness routine. Fitness and wellness guru Caroline Jordan has some advice for you: “There is no better time than right now to get started on some serious body love. I encourage you to practice your body love push-ups daily and build your body confidence strength.”

Let’s take a look at some ways you can make Jordan’s advice and your fitness goals your reality this summer:
  1. Hold yourself accountable.

Make a workout schedule and stick to it. Use an app, a fitness tracker, or even just a simple notebook to record your activity. Journal the accomplishments you make. Burn a high number of calories? Increase your speed or your weight load? Feel successful after trying a new exercise? Reflect on these experiences in your journal. Doing so can not only help you see how much you improve from week to week but it can also keep you motivated to do even more.

  1. Appreciate food as fuel.

Eating for comfort may lead you to eat too much, but seeing food as the enemy may cause you to deprive your body of the nutrients it needs. Question your relationship with food and why you make the decisions to eat what you do. Read about the science of nutrition and how different foods can do different things for your body. Do your body a favor by complementing your workout with the fuel it needs; don’t cancel out your efforts by treating yourself to foods that work against your goals.

  1. Try something new.

Is there a dance or fitness or yoga class you’ve always wanted to try? Is there a new sports league forming at your work? Have your friends or coworkers invited you out for a hike or a bike ride? Schedule it, sign up, and say yes! You could find something new that you enjoy and that you want to invest your time in. You could also give your body a chance to surprise you with its ability and strength. Who knows – it could even lead to a new project or a new connection in your professional life.

  1. Build confidence in yourself.

Wouldn’t it be nice if building confidence in yourself were as easy as hanging a motivational poster in your workspace or on your fridge and looking at it every day? Building that confidence and staying motivated to do more for yourself and for your fitness goals take time and concerted effort, but small steps can lead to a significant shift in how you see yourself. Tell yourself how proud you are of your accomplishments every day. If you’re new to fitness and you’ve just committed to climbing the stairs every day instead of taking the elevator, pat yourself on the back. If you’ve walked back into the gym this week or you’re back in the kitchen to do meal prep after a vacation full of treats and time off, give yourself some applause.

  1. Learn how to make your healthcare coverage work for your goals.

Explore your options when it comes to different types of coverage. In addition to major medical coverage, there are short-term medical plans and health benefit insurance plans (commonly known as limited medical coverage) that may help you meet your coverage needs and come with features that help you achieve your health and fitness goals. Check to see if the coverage you choose has the following:

  • Deductibles that meet your budget needs
  • Affordable doctor’s office visits so seeing your doctor is within your budget
  • Mental health coverage to provide resources, support, and/or benefits for you or your covered loved ones in need
  • Wellness initiatives to provide nutrition and/or fitness resources and/or programs
  • Telemedicine feature to provide you with video and/or phone access to doctors when you need it
  • Patient advocacy feature to help you navigate the healthcare system
Here are some features of several different types of coverage to help you decide what works best for you and your goals:

Short-Term Medical Coverage

  • Helpful if you (or a loved one) are facing life-altering transition periods such as pre-Medicare retirement, change in employment status, rolling off parental or student insurance, bridging a gap in major medical coverage or if you missed Open Enrollment (This coverage is designed solely to provide healthcare coverage during unexpected coverage gaps)
  • Flexibility in coverage length and cost (coverage duration varies by state and is non-renewable)
  • Variety of deductible and coinsurance options
  • Low copay options for in-network benefits
  • Limited preventive care available
  • Ability to cancel at any time without penalty (benefits may be limited and subject to exclusions and restrictions)
  • Does not cover pre-existing conditions
  • Coverage is not guaranteed
  • Not intended to be a replacement or alternative to ACA or other major medical plans and does not provide the minimum essential health benefits that are required; may result in a tax penalty.

Health Benefit Insurance Coverage 

  • Helpful if you (or a loved one) are anticipating rising medical expenses, are unable to afford major medical, are not eligible for short-term medical, and/or are looking for supplemental coverage to major medical plans
  • Guaranteed issue coverage if eligibility is met and available in state
  • Premiums often lower than major medical
  • Benefits such as $50-$100 paid toward doctor and specialist visits available
  • Not required to use a network of doctors – freedom to see any doctor or visit any facility of your choice (*Note: you may still exceed eligible benefit)
  • Preventive care available for as low as $50
  • Next day coverage available or little to no waiting periods for accidental injuries or sickness
  • 12 month waiting period for pre-existing conditions (limitations and exclusions may apply)
  • Not a replacement for major medical coverage
  • Does not count as minimum essential coverage required by the Affordable Care Act and is not suitable to serve as sole medical coverage

ACA Coverage

  • Helpful if you (or a loved one) are seeking major medical but may not be able to afford it, have a pre-existing condition, and/or need a broad array of health benefits
  • Option to change plan every year and to stay on policy as long as needed
  • Renews annually
  • Provides coverage for pre-existing conditions; you can’t be rejected based on health
  • Provides preventive care
  • Provides the option for subsidies to lower costs
  • Provides minimum essential health benefits
  • Must enroll during the Open Enrollment period, the Special Enrollment period, or when a qualifying life event occurs

Note: It is important to keep in mind that while short-term and health benefit insurance coverage can provide valuable benefits, neither one is intended to be a replacement nor an alternative to ACA or other major medical plans. These types of coverage do not provide the minimum essential health benefits that are required and will not help to avoid the fee for not carrying health insurance.

 

With our leading edge tools and technologies, we’re upgrading how you experience your choice of coverage.

Stay tuned to our next blog post!

Click here to join our Facebook community for more information about your health and your healthcare coverage.

 

crisp dollar bill in front of white brick wall

Understanding Your Out of Pocket Expenses 101

There’s no doubt that the world of health insurance is challenging. Whether you’re researching new coverage or trying to understand your current coverage, you may feel overwhelmed with the laundry list of options, features, and expenses. It’s likely that you depend on your agent’s guidance and expertise to help you select the coverage that fits your health realities and your lifestyle.

It’s a good idea to have an agent you can trust, but it’s also a good idea to have an understanding of out of pocket expenses before choosing an agent. This will help you understand how a policy will impact your wallet and help you identify which questions to ask your agent before making a final decision.

Let’s take a look at some of these expenses and consider how those they relate to two popular coverage options: short-term medical and health benefit insurance plans.

Deductible

This refers to the amount you pay for yourself before your insurance carrier pays benefits.

If you’re concerned about the cost of deductibles when facing common illnesses such as a cold, an ear infection, pink eye, or strep throat, you may be interested in coverage that includes a telemedicine as a feature.

Telemedicine meets you where you are by allowing you to connect with doctors via phone, video, smartphone, or computer and reducing travel time, anxiety, and time away from family and responsibilities. This feature is available with many short-term medical and health benefit insurance plans as well as traditional healthcare coverage plans.

Copay

This refers to the amount you pay to your providers at the time of service. The amount may vary depending on the type of service you receive and typically does not count toward your deductible.

Affordability is undoubtedly one of your primary concerns when choosing healthcare coverage. Many short-term medical plans offer low out of pocket copays for doctor’s office visits and wellness care. However, the benefits may be more restricted as well since these plans do not need to meet the 10 essential health benefits. They also do not cover preexisting conditions.

If you need another type of coverage and/or if you are considering supplementing your major medical coverage, you may benefit from health benefit insurance, as this type of policy may be cost effective and provides cash benefits to pay for a variety of expenses, including copays. Keep in mind that there may be limitations and/or restrictions, so be sure to fully review the circumstances under which payment can be received.

Coinsurance

This refers to the amount you pay to your provider for services rendered after you pay your deductible and after your carrier covers its portion. This amount is a form of cost sharing and is in addition to the copay that is paid at the time of the visit.

Short-term medical plans offer a variety of coinsurance options, including a 100%/0% option. This can allow you to circumvent a coinsurance payment and would task your carrier with paying 100% of the fees. Keep in mind that short term insurance plans do not cover preexisting conditions and are not required to cover 10 essential health benefits, including maternity and newborn care, mental health and substance abuse disorder services. Check any plan details carefully to understand what is covered.

Health benefit insurance plans do not offer coinsurance options, as they provide fixed cash benefits for specific covered expenses.

 

Note: It is important to keep in mind, that while short-term and health benefit insurance coverage can provide valuable benefits benefits, neither one is intended to be a replacement nor an alternative to ACA or other major medical plans. These types of coverage do not provide the minimum essential health benefits that are required and will not help to avoid the fee for not carrying health insurance.

 

With our leading edge tools and technologies, we’re upgrading how you experience your choice of coverage.

Stay tuned to our next blog post!

Click here to join our Facebook community for more information about your health and your healthcare coverage.