Health Insurance for Self-Employed People, Part 4

Criteria to Look at when Choosing a Plan, the Application Process, and What to do After  You’ve Purchased Your Plan

When you’re looking at health insurance plans, there are several criteria you need to consider – this post will discuss those criteria and why they’re important, and then we’ll get into the application process and what to do after you’ve purchased your plan. 

Criteria to Look at when Choosing a Plan

Health benefits – Which plans provide the must-have benefits you’ve identified? Buy only what is important to you to keep your costs low. Avoid plans offering expensive benefits (like maternity or prescription drugs) if you don’t need them

Costs – Which plans fall within your budget when it comes to premium, deductible, co-payments and coinsurance? Consider a high-deductible plan if your primary requirement is a low monthly premium.

Physician Network – Do you have a favorite doctor you want to keep? Which plans does he or she accept?

Brand – Are there brand-name carriers that you prefer? Are there any you want to avoid?

Consumer and industry reviews – What do others have to say about the insurance company you’re considering?

The Application Process 

Completing the Application – Once you’ve selected the health insurance plan that you’d like, complete the application. If you’re working through an online health insurance agent, you may be able to complete your application online. Be sure to answer all questions honestly. You may find that you’ll need to contact your doctor’s office for information like the date of your last checkup. It’s better to provide correct information up front than for the insurance company to discover that you omitted specific elements of your medical history.

Submitting Your Application –  If you’re applying through an online health insurance agent, you may be able to submit your application electronically, to save time and hassle. You may be required to provide a check or credit card for your first month of coverage. If you are denied coverage, this money will be refunded to you by the insurance company. Your application materials will be forwarded by your agent to the health insurance company where it will be reviewed. If you submit your application through eHealthInsurance, we will inform you of the insurance company’s decision as soon as possible. You may receive any one of the following responses:

  • Approved – Once approved, your health insurance coverage will begin on the “effective date” confirmed by the insurance company.
  • Approved, with conditions – The insurance company may offer you coverage but limit benefits for specific conditions based on your medical history.
  • More information is required – In some cases, the health insurance company will ask for more information regarding your application, and may request medical records from your doctor before coming to a final decision.
  • Denied – If the insurance company declines your application, please talk to the insurance company.  There may be reason to appeal the decision or try again with a different insurance company. If not, the insurance company may be able to tell you about other options available.

What to do After Purchasing your Plan

If you have questions about your claims – If you have questions or concerns about how a medical claim was processed, your first step is to contact the health insurance company’s customer service department. If they are unable to assist you or you feel that they’re not addressing your concerns, contact your health insurance agent for help. Because of his or her relationship with the health insurance company, your agent can help you understand how your benefits work and serve as your advocate to clear up billing disputes.

Adding and removing dependents  – Marriage, the birth of a child, or an older child’s college graduation may mean that you need to make changes to the list of persons covered by your health insurance plan. Contact your health insurance company for instructions on how to do so.

Changes to Monthly Premiums and Benefits – Depending on how long you keep your new coverage, you may find that the insurance company occasionally changes the monthly premium you pay for your coverage. They may also make changes to your list of covered benefits. Be sure to read through the updates provided by your insurance company and contact their customer service department or your agent for more information.

An annual health insurance check-up – eHealthInsurance recommends health insurance policyholders take a fresh look at their medical coverage once a year to make sure they still have the right plan for their needs and budget. To give your health insurance coverage a check-up, ask yourself the following questions:

  • Am I paying too much for coverage?  If you’re healthy and had few or no health insurance claims in the past year, you may be able to reduce your monthly premiums by switching to a plan with a higher deductible. If you do switch to a higher deductible plan, be sure you can afford that deductible in case of an accident or unexpected illness.
  • Does my current plan cover the services I need?  If you’re paying for benefits you don’t use (such as prescription drugs, maternity or chiropractic care), you may be able to find a plan with a lower monthly premium that excludes those benefits. On the other hand, if you find that you’re paying too much out of pocket for recurring medical services, you may want to consider a plan that covers these at a higher level, even if your monthly premium increases.
  • Have I experienced any big life changes? If you were recently married or divorced, had a child, or gained or lost income — or if you anticipate these things happening in the year to come-, it may be time to reconsider your health insurance options. And if you recently turned 30, 40, 45, 55 or 60 years old, you may find that your rates were increased because of your age. Take a look at quotes from other health insurance companies in your area to make sure you’re not paying too much.
  • Do I have access to the doctors I want to see? If you’d like to be seen by a specific doctor or hospital not covered by your current plan, use the “Plans with My Doctor” tool at to find out which health plans that doctor accepts. If you’re on an HMO plan and want to be able to see a specialist without a referral, you may want to consider a different type of coverage — like a PPO plan, for example.

That’s it for this post – in the last post, I’ll provide information on some health insurance companies that cover people who work from home.

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