Stop buying health insurance, start buying Health Care – Your Four Point Strategy for 2012

Your firm has a comprehensive costly top tier insurance plan with unlimited benefits.  When a catastrophic illness or injury impacts you, your medical insurance will LIKELY fail your needs.  Why?  Even top of the line expensive health insurance policies are no longer structured to fully cover your health care needs.  There are so many limitations and protocols in group health insurance policies that more and more people are experiencing for the first time, the pain of the growing gap between health insurance coverage and their health care needs.

When you or your family members are faced with a life threatening illness or sudden injury, you will work non-stop to be treated by the best medical professionals in the quickest time possible utilizing the best of the medical system.  Issues of costs, insurance company procedures: doctor limitations, facility limitations, and even the hours needed to get appointments with the right people take large amounts time. 

Months later, when the bills are totaled, your health insurance policy will likely cover 50-60% of the total costs.  Non covered charges, cost sharing provisions, large copays, non-network doctors (particularly surgeons) and non-network facilities are commonly part of your health care solutions to complex issues. 

Out of Network = Out of Coverage

Insurance companies have limited the out of network reimbursable coverage through artificially low limits on what fees are “reasonable”.  While historically, out of network coverage fees were calculated based on a metric called “usual and customary” (70th or 80th percentile being recognized as appropriate), many insurance companies have moved to a method of calculation using 140% of the Medicare rates as appropriate.  We estimate the 140% method of calculations to a 30-40% reduction in fee coverage!  On a complex medical issue, this is an additional $30,000 – $40,000 out of your pocket.

Your 2012 Strategy:

Your simple health insurance policy is not enough to cover your health care needs.  While health insurance plans are the foundation for your total health care needs, today’s buyers need to consider:

1) Tax Optimized Plans – Out of pocket costs X your tax rate, ie 1.45 = real cost of out of pocket health care spending.  Know your numbers.

2)  HSA, FSA, HRA type plans – these are critical tools to consider in your new vision for funding health care, not health insurance.

3)  Group health care supplemental plan – A correctly implemented Group supplemental plan for you and your key staff members is fully insured, compliant with tax rules, a tax deductible business expense for the firm and is not taxable income to the employees. The basic benefit plan covers out of pocket expenses on a “per occurrence” basis each year.

4)  Concierge medical advisors.  Group plans can be set up for your firm where you receive unbiased, up to date medical information when faced with a new illness or condition.  They can also assist you in getting timely appointments with the right doctors when time is critical to respond to your condition.

Make 2012 the year you stopped buying health insurance and start buying smart health care solutions.  The right planning now will set you up to be financially secure when you are hit with health challenges in the future.

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