Limited Benefit Health Plans… the Solution for the Self Employed?

April 6, 2021

If there is anything we can all agree on in this time of division and change it is that the health insurance system is broken. Premiums continue to skyrocket and larger and larger deductibles hit our wallets harder than ever. This is particularly true for the self employed. These hard working entrepreneurs often find themselves priced out of the major medical market. They make to large of an income to qualify for any federal subsidies and too little income to afford the outrageous premiums. I believe limited health plans offer an affordable alternative.

What is a limited Health Plan?

First, a limited benefit health plan is not comprehensive major medical coverage. A limited benefit health plan offers set benefits for the most common medical procedures. Our plans cover routine doctor visits, visits to see a specialist (without a referral), laboratory services, emergency room benefits, in patient and out patient hospital benefits, surgery benefits, and prescription benefits. The plan benefits are ‘fixed” and not flexible. Here is an example: our plans pay $125.00 for a visit to the doctor. My doctor charges me $75.00 for a visit. The plan then would pay $75.00 to my doctor and send me a check for the remaining $50.00. However, if a doctor charges $500.00 per visit the plan pays $125.00 leaving the insured with a bill of $375.00. So the policyholder is rewarded for shopping for who provides treatment and how much it costs. Best of all, unlike most major medical plans, our plans have no co payment/no deductible. The plans pay exactly what the fixed benefit is with no reduction of payment for deductible.

Compliance Issues for Employers?

It is important to note that the limited benefit plans alone do not meet the employer mandate required for employers with more than 50 employees. However, by paring the plans with a MEC (Minimum Essential Coverage) plan, the plans do meet the federal mandate for employers with more than 50 employees. As a result I have been able to assist several companies looking for affordable solutions to the high cost of providing major medical. One such company w with 100 employees, saved a $100,000 annually by offering the limited benefit plans.

Solutions That Count!

While limited benefit plans may not be a good fit for those with chronic illness, they offer an affordable solution that is typically 50% less than major medical. Providing coverage that offers financial security should a sickness or accident occur. Our agency has helped hundreds of self employed and small to medium businesses with these coverages. We can help you too!


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