The Female Founder’s Guide To Picking The Best Health Insurance Plan

Six terms you must know when shopping for

your health plan

Premium

The price of your policy

You may be accustomed to getting this deducted bi-weekly from your
paycheck. However, when you have to buy your own health insurance,
premiums must be paid monthly. It may be tempting to select the lowest premium, but beware, always take a deep dive into the coverage, limitations and exclusions of your policy.

Ask:

1. What am I getting for this price?
2. What do I have to pay in addition to my monthly premium?

BONUS TIP: Ask about premium increases.

1. When can I expect a raise?
2. How much will my price go up?
3. Is the premium tied to my income? Income-based plans can be slippery for entrepreneurs.

Deductible

The amount you have to pay before the insurance company will pay your benefits.

Often, this is more important than the premium. The deductible dictates your immediate out of pocket expenses when you use your policy. The deductible is NOT the same as your “max-out-of pocket”. Find out both.
Use prior years’ statistical data to determine projected deductible levels

Ask: Do I see myself meeting my deductible this year?

BONUS TIP: Healthy entrepreneurs should seek the lowest deductible plan. In the
unlikely event that you have a catastrophic incident, you’ll want to make sure
insurance companies are paying your bills, not you!

Network

The pool of providers you have access to.

The 3 most common types of networks are HMO ‘s (Health Maintenance Organization), PPO’s (Preferred Provider Organization) and EPO’s (Exclusive Provider Organization)

BONUS TIP: Pick the PPO! it’s the best choice for entrepreneurs since you are not confined to a particular state. Additionally, it’s easy to see preferred specialists.

Co-Pay vs Co-Insurance

A co-pay is a fixed dollar amount you have to pay to a provider before you can
access services. A co-insurance is a percentage of the total billed amount that you have to pay
for your medical services.

Ask:
1. What is my co-pay for going to a primary care doctor versus a specialist?
2. What is my co-insurance 80/20, 70/30?
3. Do I have to meet my deductible before the coinsurance?

BONUS TIP:
1. There are plans with ZERO copays and coinsurances. But that does not
necessarily mean that all your services are covered at 100%! It’s prudent to delve deeper into your policy coverage.
2. 80/20 co insurance means that your insurance will pay 80% of the billed amount and you pay 20%.

Limitations and Exclusions

This is the fine print of your policy that clearly states the specific situations and scenarios that are non-covered.

Ask:
1. Is there a waiting period for my benefits to start?
2. What are the conditions that are not covered at all by my policy?
3. Is there a time limitation for coverage for pre-existing conditions?

BONUS TIP:
1. If you are concerned about coverage for a specific condition, ask directly if and how that is covered on your policy. Are there any limitations and exclusions around the things you need coverage for?

Maximum-out-of pocket

Your max out of pocket is the MOST you have to pay out of your own pocket for covered services in a plan year.

Ask:
1. Is my max out of pocket for a calendar year or policy year?
2. What is considered non- covered that does not fall under my max out of pocket?
3. Is there a limit to the coverage amount for my max out of pocket in a plan year?

BONUS TIP:
1. Try to set aside your funds for your maximum out of pocket in a separate account. That way you know that no matter what happens, you will always be protected against medical bankruptcy.