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SPECIFIED BENEFIT LIMITED MEDICAL/INDEMNITY PLANS
Benefits of Limited Medical/Indemnity Plans
- These Plans pay a specified dollar benefit for medical services such as hospitalization, surgery, and physician office visits.
- Premiums can be very affordable
- Member receives a cash payment upon a qualifying event such as an accident, specific critical illnesses, or hospital admissions as specified in the Plan
- Applications can be made any time of the year, with no waiting for Open Enrollment
- Generally, these Plans have pre-negotiated rates with a healthcare provider network
Problems with Limited Medical/Indemnity Plans
- Benefits are tied to specific incidences, such as an accident, critical illness, doctor visits, or hospital admission, depending on the policy
- There may be no benefits for general conditions such as diabetes, arthritis, etc.
- Medical expenses are often capped at a rate much lower than major medical Plans
- Certain pre-existing conditions may not be covered or only covered twelve months after the effective date
ASSOCIATION-SPONSORED HEALTH PLANS
Benefits of Association Health Plans.
- These Plans are designed for ages 55 to 64 years
- May enroll at any time during the year
- Usually, utilize a Health & Welfare Benefit Trust structure that is wrapped under the Association
- Usually contain several Plans (Bronze through Gold)
- Utilize nationwide group PPO networks (i.e., Cigna or Blue Cross/ Blue Shield)
- The Trust administers the various Plans and uses a Third-Party Administrator (TPA) to verify benefits and pay claims on the part of the Trust
- These Plans are designed for Self-Employed, Independent Contractors, Sole Proprietors, Managing Members of LLCs, Sub-S Shareholders, other Small Business Owners with fewer than five employees, and W2 employees where the company does not provide group coverage
Problems with Association Health Plans
- Because the Trust administers the Plans, they act as the self-insured entity paying the actual claims
- The trustee may ask health and pre-existing condition-related questions (underwriting)
- The trustee may exclude joining the Trust due to adverse health history or pre-existing conditions
HEALTH CARE SHARING MINISTRY PLANS
Benefits of Member Health Share Ministry Plans
- Plans tend to mimic ACA mandates
- Monthly rates are usually 30% to 50% less than the cost of ACA (Obamacare) Plans
- Usually, utilize a nationwide PPO network
- Enroll year-round; no qualifying event is needed
Problems with Member Health Share Ministry Plans
- Depending on Plan, maximum lifetime benefits may be limited to $1,000,000
- Any pre-existing conditions at the time of enrollment may be excluded or for up to 24 months after enrollment
- Pregnancy benefits may be excluded or excluded for the first ten months after enrollment
