A breakdown of coverage options.....

By
Services for Real Estate Pros with Farmers Insurance

There is simply a staggering range in the quality, affordability, and structure of medical plans.  Since I'm a consumer and an insurance broker, I see this from a wide perspective.   Here's what I see:

  • All group plans are not created equal

I've had customers who were desperate to get on a group plan, I've had customers who were on a group and wanted out because they felt they were paying too much or felt that the benefits were inadequate, and I've had customers who loved their group coverage, but wanted indivual coverage for a family member because it cost more to add them under the group than it did to cover them individually.  Moral of the story;  It just depends.   My wife works for the county hospital and has great benefits, but I cover myself and my daughter on an individual basis because it is cheaper than to add us as dependents under her group plan.   The other wildcard of group coverage how much of the monthly premium the employer picks up.   I know people who's group plan pays 100% of their premium, I know others who pay half of their monthly premium.  

  • Individual Plans and the pre-existing condition

This is the issue that can really make it hard on people who, for whatever reason, are not eligible for group coverage.  In general, individual plans won't cover pre-existing conditions such as asthma, ulcers, chronic joint problems, etc.   In some cases, the individual can get the coverage, but will be excluded for any benefits covering that specific condition.   Moral of the story; individual plans are great if you are healthy to begin with. 

  • HSA plans

Essentially, an HSA plan is an individual plan minus the co-pay benefit for doctors visits and prescriptions, plus a health savings account with tax benefits and potential investment options.   Again, on the individual basis, this works better if you are healthy to begin with.  The HSA can allow you to accrue a discretionary lump sum to direct pay for a wide array of medical costs including dental and vision fees.  Moral of the story:  did you or did you not contribute enough to the HSA to pay your exposure for office visits and prescriptions?   Personally, I like the HSA because of the tax benefits and the potential for investment----IF YOU ARE LUCKY ENOUGH TO STAY SAFE AND HEALTHY ENOUGH NOT TO HAVE TO USE THOSE FUNDS.

  • Catastophic Plans

In general terms, the catastophic plan is an accident indemnity policy with various optional riders that can be attached to it.   Some examples of the riders can be:  $400/day payout for every day you are in the hospital,  $1,000 lump sum for being admitted to the hospital, $40,000 lump sum for critical illness(cancer, heart attack, stroke).   Different carriers will have various additional rider choices, but that's it in a nutshell.   There are no benefits for doctors office copays and prescription copays.  Usually.  There are some of these plans that will offer an discount card in lieu of copays.  Moral of the story; this is limited coverage with huge gaps, but given the right situation, it can save you a bundle.

Many of my customers will take the comprehensive indiviual medical plan and the catastophic plan together.   The catastophic benefits are non-coordinating, meaning they pay direct to the insured regardless of other insurance in force. 

 

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Rainmaker
424,010
Frances C. Rokicki
Fran Rokicki Realty, LLC - Bolton, CT
Broker-Mentor,CRS
I am on my husband's group plan, looking for an individual plan for myself.  Would you believe, we live 12 minutes from the insurance capitol of the world?  Hartford, CT ~  I need to move that to the top of my list of things to do;)
October 21, 2007 09:05 AM #1
Rainer
27,784
Melissa Wagner
Leo Parker Real Estate & Auction - Woodbury, TN
Good subject! I would love nothing more than to be able to only work in the Real Estate Field but because of a chronic condition I have- endometriosis & mild asthma, individual and HSA's are just not option for me and I am left with no choice but to work at a minimum, enough part time hours elsewhere to qualify for group. I supplement this by work 24+ hours per week at my local hospital solely to qualify for their insurance. Bottom line I typically work 60+ hours per week when I add in my RE hours too. My husband is self-employed so that doesn't help the situation. I would love to see RE companies all qualify for group policies eventually so all of my energy could be spent on what I love to do.
October 24, 2007 10:43 PM #2
Rainer
20,736
Seth Callen
Farmers Insurance - Lawton, OK
You might check with your local chamber of commerce.  Many of them offer a group plan to members. 
October 29, 2007 08:48 AM #3
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Rainer
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Seth Callen

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