Small Business Health Insurance – The Best Policy Is A Great Agent

I have been a health insurance broker for over a decade and every day I read more and more “horror” stories that are posted on the Internet regarding health insurance companies not paying claims, refusing to cover specific illnesses and physicians not getting reimbursed for medical services. Unfortunately, insurance companies are driven by profits, not people (albeit they need people to make profits). If the insurance company can find a legal reason not to pay a claim, chances are they will find it, and you the consumer will suffer. However, what most people fail to realize is that there are very few “loopholes” in an insurance policy that give the insurance company an unfair advantage over the consumer. In fact, insurance companies go to great lengths to detail the limitations of their coverage by giving the policy holders 10-days (a 10-day free look period) to review their policy. Unfortunately, most people put their insurance cards in their wallet and place their policy in a drawer or filing cabinet during their 10-day free look and it usually isn’t until they receive a “denial” letter from the insurance company that they take their policy out to really read through it.

The majority of people, who buy their own health insurance, rely heavily on the insurance agent selling the policy to explain the plan’s coverage and benefits. This being the case, many individuals who purchase their own health insurance plan can tell you very little about their plan, other than, what they pay in premiums and how much they have to pay to satisfy their deductible.

For many consumers, purchasing a health insurance policy on their own can be an enormous undertaking. Purchasing a health insurance policy is not like buying a car, in that, the buyer knows that the engine and transmission are standard, and that power windows are optional. A health insurance plan is much more ambiguous, and it is often very difficult for the consumer to determine what type of coverage is standard and what other benefits are optional. In my opinion, this is the primary reason that most policy holders don’t realize that they do not have coverage for a specific medical treatment until they receive a large bill from the hospital stating that “benefits were denied.”

Sure, we all complain about insurance companies, but we do know that they serve a “necessary evil.” And, even though purchasing health insurance may be a frustrating, daunting and time consuming task, there are certain things that you can do as a consumer to ensure that you are purchasing the type of health insurance coverage you really need at a fair price.

Dealing with small business owners and the self-employed market, I have come to the realization that it is extremely difficult for people to distinguish between the type of health insurance coverage that they “want” and the benefits they really “need.” Recently, I have read various comments on different Blogs advocating health plans that offer 100% coverage (no deductible and no-coinsurance) and, although I agree that those types of plans have a great “curb appeal,” I can tell you from personal experience that these plans are not for everyone. Do 100% health plans offer the policy holder greater peace of mind? Probably. But is a 100% health insurance plan something that most consumers really need? Probably not! In my professional opinion, when you purchase a health insurance plan, you must achieve a balance between four important variables; wants, needs, risk and price. Just like you would do if you were purchasing options for a new car, you have to weigh all these variables before you spend your money. If you are healthy, take no medications and rarely go to the doctor, do you really need a 100% plan with a $5 co-payment for prescription drugs if it costs you $300 dollars more a month?

Is it worth $200 more a month to have a $250 deductible and a $20 brand name/$10 generic Rx co-pay versus an 80/20 plan with a $2,500 deductible that also offers a $20 brand name/$10generic co-pay after you pay a once a year $100 Rx deductible? Wouldn’t the 80/20 plan still offer you adequate coverage? Don’t you think it would be better to put that extra $200 ($2,400 per year) in your bank account, just in case you may have to pay your $2,500 deductible or buy a $12 Amoxicillin prescription? Isn’t it wiser to keep your hard-earned money rather than pay higher premiums to an insurance company?

Yes, there are many ways you can keep more of the money that you would normally give to an insurance company in the form of higher monthly premiums. For example, the federal government encourages consumers to purchase H.S.A. (Health Savings Account) qualified H.D.H.P.’s (High Deductible Health Plans) so they have more control over how their health care dollars are spent. Consumers who purchase an HSA Qualified H.D.H.P. can put extra money aside each year in an interest bearing account so they can use that money to pay for out-of-pocket medical expenses. Even procedures that are not normally covered by insurance companies, like Lasik eye surgery, orthodontics, and alternative medicines become 100% tax deductible. If there are no claims that year the money that was deposited into the tax deferred H.S.A can be rolled over to the next year earning an even higher rate of interest. If there are no significant claims for several years (as is often the case) the insured ends up building a sizeable account that enjoys similar tax benefits as a traditional I.R.A. Most H.S.A. administrators now offer thousands of no load mutual funds to transfer your H.S.A. funds into so you can potentially earn an even higher rate of interest.

In my experience, I believe that individuals who purchase their health plan based on wants rather than needs feel the most defrauded or “ripped-off” by their insurance company and/or insurance agent. In fact, I hear almost identical comments from almost every business owner that I speak to. Comments, such as, “I have to run my business, I don’t have time to be sick! “I think I have gone to the doctor 2 times in the last 5 years” and “My insurance company keeps raising my rates and I don’t even use my insurance!” As a business owner myself, I can understand their frustration. So, is there a simple formula that everyone can follow to make health insurance buying easier? Yes! Become an INFORMED consumer.

Every time I contact a prospective client or call one of my client referrals, I ask a handful of specific questions that directly relate to the policy that particular individual currently has in their filing cabinet or dresser drawer. You know the policy that they bought to protect them from having to file bankruptcy due to medical debt. That policy they purchased to cover that $500,000 life-saving organ transplant or those 40 chemotherapy treatments that they may have to undergo if they are diagnosed with cancer.

So what do you think happens almost 100% of the time when I ask these individuals “BASIC” questions about their health insurance policy? They do not know the answers! The following is a list of 10 questions that I frequently ask a prospective health insurance client. Let’s see how many YOU can answer without looking at your policy.

1. What Insurance Company are you insured with and what is the name of your health insurance plan? (e.g. Blue Cross Blue Shield-“Basic Blue”)

2. What is your calendar year deductible and would you have to pay a separate deductible for each family member if everyone in your family became ill at the same time? (e.g. The majority of health plans have a per person yearly deductible, for example, $250, $500, $1,000, or $2,500. However, some plans will only require you to pay a 2 person maximum deductible each year, even if everyone in your family needed extensive medical care.)

3. What is your coinsurance percentage and what dollar amount (stop loss) it is based on? (e.g. A good plan with 80/20 coverage means you pay 20% of some dollar amount. This dollar amount is also known as a stop loss and can vary based on the type of policy you purchase. Stop losses can be as little as $5,000 or $10,000 or as much as $20,000 or there are some policies on the market that have NO stop loss dollar amount.)

4. What is your maximum out of pocket expense per year? (e.g. All deductibles plus all coinsurance percentages plus all applicable access fees or other fees)

5. What is the Lifetime maximum benefit the insurance company will pay if you become seriously ill and does your plan have any “per illness” maximums or caps? (e.g. Some plans may have a $5 million lifetime maximum, but may have a maximum benefit cap of $100,000 per illness. This means that you would have to develop many separate and unrelated life-threatening illnesses costing $100,000 or less to qualify for $5 million of lifetime coverage.)

6. Is your plan a schedule plan, in that it only pays a certain amount for a specific list of procedures? (e.g., Mega Life & Health & Midwest National Life, endorsed by the National Association of the Self-Employed, N.A.S.E. is known for endorsing schedule plans) 7. Does your plan have doctor co-pays and are you limited to a certain number of doctor co-pay visits per year? (e.g. Many plans have a limit of how many times you go to the doctor per year for a co-pay and, quite often the limit is 2-4 visits.)

8. Does your plan offer prescription drug coverage and if it does, do you pay a co-pay for your prescriptions or do you have to meet a separate drug deductible before you receive any benefits and/or do you just have a discount prescription card only? (e.g. Some plans offer you prescription benefits right away, other plans require that you pay a separate drug deductible before you can receive prescription medication for a co-pay. Today, many plans offer no co-pay options and only provide you with a discount prescription card that gives you a 10-20% discount on all prescription medications).

9. Does your plan have any reduction in benefits for organ transplants and if so, what is the maximum your plan will pay if you need an organ transplant? (e.g. Some plans only pay a $100,000 maximum benefit for organ transplants for a procedure that actually costs $350-$500K and this $100,000 maximum may also include reimbursement for expensive anti-rejection medications that must be taken after a transplant. If this is the case, you will often have to pay for all anti-rejection medications out of pocket).

10. Do you have to pay a separate deductible or “access fee” for each hospital admission or for each emergency room visit? (e.g. Some plans, like the Assurant Health’s “CoreMed” plan have a separate $750 hospital admission fee that you pay for the first 3 days you are in the hospital. This fee is in addition to your plan deductible. Also, many plans have benefit “caps” or “access fees” for out-patient services, such as, physical therapy, speech therapy, chemotherapy, radiation therapy, etc. Benefit “caps” could be as little as $500 for each out-patient treatment, leaving you a bill for the remaining balance. Access fees are additional fees that you pay per treatment. For example, for each outpatient chemotherapy treatment, you may be required to pay a $250 “access fee” per treatment. So for 40 chemotherapy treatments, you would have to pay 40 x $250 = $10,000. Again, these fees would be charged in addition to your plan deductible).

Now that you’ve read through the list of questions that I ask a prospective health insurance client, ask yourself how many questions you were able to answer. If you couldn’t answer all ten questions don’t be discouraged. That doesn’t mean that you are not a smart consumer. It may just mean that you dealt with a “bad” insurance agent. So how could you tell if you dealt with a “bad” insurance agent? Because a “great” insurance agent would have taken the time to help you really understand your insurance benefits. A “great” agent spends time asking YOU questions so s/he can understand your insurance needs. A “great” agent recommends health plans based on all four variables; wants, needs, risk and price. A “great” agent gives you enough information to weigh all of your options so you can make an informed purchasing decision. And lastly, a “great” agent looks out for YOUR best interest and NOT the best interest of the insurance company.

So how do you know if you have a “great” agent? Easy, if you were able to answer all 10 questions without looking at your health insurance policy, you have a “great” agent. If you were able to answer the majority of questions, you may have a “good” agent. However, if you were only able to answer a few questions, chances are you have a “bad” agent. Insurance agents are no different than any other professional. There are some insurance agents that really care about the clients they work with, and there are other agents that avoid answering questions and duck client phone calls when a message is left about unpaid claims or skyrocketing health insurance rates.

Remember, your health insurance purchase is just as important as purchasing a house or a car, if not more important. So don’t be afraid to ask your insurance agent a lot of questions to make sure that you understand what your health plan does and does not cover. If you don’t feel comfortable with the type of coverage that your agent suggests or if you think the price is too high, ask your agent if s/he can select a comparable plan so you can make a side by side comparison before you purchase. And, most importantly, read all of the “fine print” in your health plan brochure and when you receive your policy, take the time to read through your policy during your 10-day free look period.

If you can’t understand something, or aren’t quite sure what the asterisk (*) next to the benefit description really means in terms of your coverage, call your agent or contact the insurance company to ask for further clarification.

Furthermore, take the time to perform your own due diligence. For example, if you research MEGA Life and Health or the Midwest National Life insurance company, endorsed by the National Association for the Self Employed (NASE), you will find that there have been 14 class action lawsuits brought against these companies since 1995. So ask yourself, “Is this a company that I would trust to pay my health insurance claims?

Additionally, find out if your agent is a “captive” agent or an insurance “broker.” “Captive” agents can only offer ONE insurance company’s products.” Independent” agents or insurance “brokers” can offer you a variety of different insurance plans from many different insurance companies. A “captive” agent may recommend a health plan that doesn’t exactly meet your needs because that is the only plan s/he can sell. An “independent” agent or insurance “broker” can usually offer you a variety of different insurance products from many quality carriers and can often customize a plan to meet your specific insurance needs and budget.

Over the years, I have developed strong, trusting relationships with my clients because of my insurance expertise and the level of personal service that I provide. This is one of the primary reasons that I do not recommend buying health insurance on the Internet. In my opinion, there are too many variables that Internet insurance buyers do not often take into consideration. I am a firm believer that a health insurance purchase requires the level of expertise and personal attention that only an insurance professional can provide. And, since it does not cost a penny more to purchase your health insurance through an agent or broker, my advice would be to use eBay and Amazon for your less important purchases and to use a knowledgeable, ethical and reputable independent agent or broker for one of the most important purchases you will ever make….your health insurance policy.

Lastly, if you have any concerns about an insurance company, contact your state’s Department of Insurance BEFORE you buy your policy. Your state’s Department of Insurance can tell you if the insurance company is registered in your state and can also tell you if there have been any complaints against that company that have been filed by policy holders. If you suspect that your agent is trying to sell you a fraudulent insurance policy, (e.g. you have to become a member of a union to qualify for coverage) or isn’t being honest with you, your state’s Department of Insurance can also check to see if your agent is licensed and whether or not there has ever been any disciplinary action previously taken against that agent.

In closing, I hope I have given you enough information so you can become an INFORMED insurance consumer. However, I remain convinced that the following words of wisdom still go along way: “If it sounds too good to be true, it probably is!” and “If you only buy on price, you get what you pay for!”

©2007 Small Business Insurance Services, Inc. http://www.smallbusinessinsuranceservices.com

Small Business Owners: Wondering What It Will Entail to Get Organized?

You have registered your company. You have found the perfect, cozy spot to serve your customers. You have hired your staff. You have stocked up the shelves. You have put up the signs. And you are now open for business.

After a grueling period of working towards your business launch, the dust has finally settled. Now what? While you can still afford to sit back, and before you get fully occupied with customer-servicing, you can spend some time setting up some housekeeping procedures to set everything in motion when it comes to record-keeping.

Bank and Credit Card Statements. For small businesses, bank and credit card statements serve as the cornerstone for record-keeping. It is therefore imperative to maintain these two accounts separate from your personal account.

  • Corporate or business bank account

Open a separate bank account for your business. Use this for all business banking. Try to avoid using a personal account for business transactions as this practice increases the risk of items being overlooked.

  • Corporate or business credit card

Obtain a separate credit card to be used exclusively for your business (it can be a personal card, but different from the card you use for personal transactions). Use monthly statement as a way to keep track of expenses to be supported by slips with details of the expense (like name of the client, description of the item and so on). Slips should be filed regularly in files preferably by expense type. This will facilitate accounting based on the credit card monthly statements.

Cash transactions. All items paid for in cash are to be receipted and receipts kept. Ideally, expenses paid out-of pocket or personally should be summarized and reimbursed by the company by way of an expense report. The form should show detailed description of the expense. There should be separate envelopes or folders where items paid for in cash should be kept to facilitate accounting.

Home-office expenses. Personally paid items such as rent or home mortgage, interest, utilities, insurance, repairs, property taxes, condo fees, etc. should be tallied or at least closely estimated to allow proper calculation of business use of home/rent expense. Home office space should be calculated at the start of the business.

Vehicle usage. Car usage should be tracked to identify and collect information on all business-related trips. You should be able to calculate/estimate the business use percentage and total kilometres driven.

Vehicle-related expenses. All car expenses including loan interest, lease payment, car depreciation or capital cost allowance, gas, repairs, insurance license, CAA etc. are deductible expenses but need to be pro-rated based on the percentage of business use. It is therefore important to track all costs of car operations. Parking is generally 100% deductible.

Telephone and communication expenses. Long distance phone should be tracked to allocate claims. Separate business phone line, cellphone, internet bills are all deductible. Bills for home phone lines are not claimable.

Document-keeping. All source documents should be filed according to expense type or supplier reference to facilitate location should questions arise or if bank and credit card records are not sufficient. This need not be filed as a monthly breakdown; yearly filing is fine.

Corporate year-end. Determining fiscal year-end for corporation is flexible during the first year of operations as no pre-setting of fiscal year-end is required until the first tax returns are filed. This decision depends on profitability and the possibility that income from employment or other sources will come back into earnings in the near future.

Unincorporated entities’ year-end. For sole proprietorship, self-employed, and partnerships, it’s a calendar year-end: December 31st. If you are an eligible individual, you may be able to use an alternative method of reporting your business income that allows you to use a fiscal period other than calendar year-end, but you will have to make a reconciliation of business income for tax purposes to calculate the amount to report in your year-end personal tax return.

Corporate earnings. It makes sense to leave surplus income in the corporation. It provides an opportunity to pay lower tax rates (approximately 15.5% for income eligible for small business deduction generally up to $500,000) on the taxable income while it remains in the company’s books. Personal taxes will only be imposed and payable when funds are actually paid to the owner/s in the form of dividends and/or salary. Tax rates are so designed to ensure equitable taxation across the different business structures (corporation, sole proprietorship or partnership) so that the total corporate plus personal taxes never exceed regular personal taxes.

Incorporation versus unincorporated business structure. In deciding whether to incorporate or to remain unincorporated, from a taxation standpoint, considerations need to be made with regard to the possibility of short-term losses (which favours unincorporated structure), size of business, family ownership, income splitting, estate planning and other considerations.

Year-end preparation. By using the above suggestions, accounting and bookkeeping costs can be minimized at year-end. Organize your year-end documents as early as possible. This will give ample time to plan ahead and ensure that total corporate and personal tax burden are minimized. This will also allow the most time possible to plan for the use of taxes recoverable or to ensure that funds will be available to cover the taxes payable on due date.

Choosing the Best Business Banking Partner

Establishing a business banking account is one of the first things company owners need to do. These accounts are vital for obtaining accurate accounting data and keeping track of allowed tax deductions.

When business owners mix business banking along with individual accounts they will likely end up undergoing an IRS audit. The time spent clarifying expenses and providing adequate documentation can be grueling and may lead to late fees and penalties, so it’s best to start things off on the right foot.

There are quite a few ways to setup a business bank account. Owners can apply online or visit banks in-person. They can select a basic checking account or apply for accounts that include merchant services, direct deposit payroll, or an open line of credit.

Many banks offer accounts that can be connected to accounting software programs such as Peachtree or QuickBooks. Interconnecting accounting software with business accounts help managers conserve time while providing adequate documentation for tax records. Additionally, this method lets business owners access their account from various locations such as work, home, and even while traveling.

Fees associated with corporate checking accounts are usually quite a bit more expensive than personal bank accounts. The majority of banks charge companies a monthly service fee. Some charge fees for every transaction, while others charge if transactions exceed a set number. Fees are also assessed for overdrafts and electronic transfers.

Although it’s never a good idea to bounce a check, companies can avoid expensive fees by setting up overdraft protection. This involves connecting business checking accounts to a savings account or credit card. If overdraft occurs, banks automatically transfer a preset amount of money into the checking account.

It can be very helpful to comparison shop banks to find ones that offer the most benefits and assess the lowest fees. A trusted source for comparing banks is BankRate.com, which offers information about national and local banks.

Small business owners may find it advantageous to open accounts with local banks or credit unions. Local banks tend to be more flexible and willing to work with owners that don’t have pristine credit. This can be very helpful to owners that require working capital or want to apply for business credit cards.

On the other hand, national banks usually offer a broader range of services than local banks. National banks engage in lending practices for small business to Fortune 500 companies, along with providing a variety of credit card options. Additionally, national banks offer integrated accounting services such as invoicing systems and direct deposit payroll.

The best approach for locating the right bank is to create a list of anticipated financial needs for the short and long term. While it can be challenging to determine what services will be required in the next 5 years, most owners can figure out if they will need business loans or credit cards. Spending time assessing overall needs can help owners avoid having to switch banks at a later time.

When comparing banks it’s important to read the fine print and calculate the true costs of conducting business. Make certain to fully understand the fee structure and checking account requirements.

Some banks charge service fees if balances fall below a certain limit. Others set limits on the number of transactions that can be conducted each month and charge hefty fees if limits are exceeded. Over the course of a year, banking fees can cost owners hundreds of dollars.

Researching available options lets owners find cost-effective business banking and can help determine which bank would be the best partnership. One consideration is that local banks frequently participate in community events where local companies are promoted. Acquiring bank endorsement can be very beneficial, so when talking to banks be certain to inquire about the types of promotional activities they participate in.

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