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How to Understand Your Insurance Contract

Insurance is a huge part of our daily lives, and when you get a new plan you are flooded with forms and contracts. But do you really know what all the forms are and what they mean? One form, the most important form is your insurance contract. This is an important piece to be familiar with because it’s the main document you reference whenever your policy is brought up. It’s the main source of information describing your obligations and your insurance provider’s.

insurance contract with someone signing it — *Make sure you’ve read everything thoroughly. You don’t want any surprise fees down the line.*

It doesn’t take long to understand this document. We’ll get you up to speed in no time at all.

Know Your Terms

Probably the quickest way to lose someone is to speak in insurance lingo. For someone outside the industry, the lingo can get confusing. Here is a general list of broad insurance terms to get you on the same page:

Beneficiary– a person named in a policy that receives the benefits
Policy Owner or Holder– person who holds the plan
Premium– the amount paid to the insurance company to keep the policy valid
Deductible– the amount you pay out-of-pocket every year before the insurance company begins assisting
Carrier– the insurance company providing your policy
Claim– a formal request for benefits by the insured to the carrier

Everyone’s contract will be a little different, depending on the policy type. Your document should have a list of definitions in it describing what they mean.

Declarations Page

The first step anyone will tell you is to locate the declarations page and read that first. Fortunately, it comes before anything else in the insurance contract and has an overview of both the policy and you as the insured. If you’re looking for specifics, on the declarations page, you’ll find:

Who or what is insured
How long the policy will provide coverage
The deductible
The plan’s dollar limits
Your expected payment (premium)
When your payments are due

If you’re looking for answers, the declarations page is the place most likely to have them. General policy and payment details are contained therein and should be formatted to be easily read.

glasses sitting on a book for insurance contracts — *If you’re not sure about something, look it up. You don’t want to misunderstand an important term.*

Insuring Agreement

This is the meat of your contract as it covers everything the carrier will be responsible for. After you’ve familiarized yourself with the terms and oriented yourself with the declarations page, this portion will give you the in-depth look at what benefits you’ll receive from your policy.

There are two distinct types of insuring agreements that you should be aware of:

Open Perils Coverage– Previously known as “All Risk” the name was changed in the industry recently to clarify that it does not actually protect from “all” risks. This plan covers everything except for exclusions named in the contract.
Named Perils Coverage– This policy type is much more specific and details each loss that the carrier will cover, rather than state only exclusions.

You’ll find both policy types outlined considerably in this section as the carrier wishes to keep everything as clear as possible. Coverage definitions are specific for a reason.

Exclusions & Modifications

These are grouped together as the side-dishes if we’re sticking with the food metaphor. Exclusions are detailed examples of what the carrier will not provide coverage for in the policy while modifications (or endorsements) are the alterations made to the original contract. Here are examples of both exclusions and modifications:

Exclusions:

Theft exclusion
Freezing pipes and systems in a vacant property
Settling, wearing of property
Government actions

Modifications:

Additional storm coverage
Home business coverage
Detailed property item coverage (valuables or otherwise)

Conditions

Lastly, you should review the requirements to maintain your coverage. After taking note of everything in your contract, you don’t want to miss out on benefits because you failed to meet the conditions outlined in the document.

man in pink suit looking at insurance contact — *There are professionals in the industry waiting for your calls. Don’t hesitate to ask for help.*

These are actions you as the insured must take to keep your policy valid. For example, one popular condition added to most contracts involving property is to notify the police once the damage is done. If you haven’t filed a police report, or have the report handy for the insurance company, then your carrier can consider you breaching their contract, and will withhold the benefits you need to get your home or business up and running again.

Once you have all these checked off your list, you should have a well-rounded idea of what your policy will cover and how to keep it. Important details from the contract should be noted separately or highlighted on your copy(like premiums and exclusions) so that you can easily reference them later.

As always, EZ.Insure is around to assist with your insurance needs. Your agent will answer any questions you have, compare different plans for you, and even sign you up when you’re ready, free of charge and without having to worry about being hounded by endless calls. To get started simply enter your zip code in the bar above, or you can speak to an agent by emailing [email protected], or calling 888-350-1890. EZ.Insure makes the entire process easy, and quick.

QSERHA vs. Group Health, Whats Best For Your Company

Small business owners know the value of covering their employees. After all, everyone gets sick at some point. If you support your team’s wellness, you make a stronger team.

You might also see the value in comparing and then choosing the best option. Two of these are either QSERHA or group health insurance, but which one has the most value for your business? For the answer to that question, we’ll need to break each one down first.

*It is important to sit down and compare all the options available to your business.*

QSERHA

This choice was unavailable until now. The ACA has now widened the usefulness of HRAs. Previously, you couldn’t set up an account unless it was tied to a policy. For more info on this, read about 2020 HRA changes here. Thankfully, this puts a Qualified Small Employer Health Reimbursement Arrangement or QSERHA on the menu.

So, what does it offer for your business?

This option skips the sometimes expensive group health insurance plans. While you’re missing out on the robust coverage insurers provide, the cost-saving benefits might be redistributed amongst your employees.

With this HRA, you must follow the requirements: employees must already have minimum health insurance, and you have to set-up your HRA properly. Afterward, you simply make contributions to the account, and later, the funds will be available to help pay for your employee’s medical expenses, tax-free.

Group Health

It comes down to which is better for your business. To help guide your decisions, see what your answers to these questions are:

Do my employees need healthcare assistance?
Is everyone on staff covered by an HRA already?
Does my budget include funds for a robust insurance option?

After answering these, you should have a better idea of which option to go for. If not, then consider the following:

	QSERHA	Group Health
Cost	You can choose how much you contribute to the account.	Premiums vary by provider but are generally more expensive.
Participation	All employees must be offered coverage, but they do not have to accept.	Generally, around 60% of your staff must be enrolled to qualify.
Coverage	Can’t be in tandem with group health. Employers can choose to reimburse medical expenses or premiums.	Primarily covers medical, dental, and vision
Eligibility	1-49 full-time employees	2-50 employees Note: some states requirements go up to 100

Hopefully, this chart helps guide your decision. No matter which you choose, remember that the health of your employees is important to your continued business. A healthy team is a happy team. However, if your budget allows, consider choosing the group health option. You’ll have an agent to help you with the tough questions plus the bonuses offered are well worth the price tag.

If you are looking to get more coverage for your company, EZ.Insure offers solutions. Your personalized agent will answer any questions you have, compare the plans available to you, and even sign you up when you are ready, free of charge. To get started simply enter your zip code in the bar above, or you can speak to an agent by emailing [email protected], or calling 888-998-2027. EZ.Insure makes the entire process simple, easy, and quick.

Can you Cancel a Commercial Insurance Policy?

As a small business owner, you might find yourself in a situation where canceling your policy is the best solution. This comes from a variety of reasons: you have a better policy offer elsewhere, changes in your business mean you need different coverage, or you might be shifting your company’s goals altogether. Whatever your reasoning, there are a few things to consider before you cancel your insurance.

hands to cancel policy — *Think before you back out on a contract. There are more penalties than just a fee attached.*

Penalties & Changes

Often times, your insurance company will impose a penalty if you cancel it, rather than waiting to not renew. Signing the contract for your policy is to ensure you’ll pay it for the full term. It’s security for the provider.

However, if you find yourself needing to cancel, the penalty fee might actually be cheaper than trying to ride out the term or doubling up on policies. We know rising insurance rates play a part in policy changes, but here are a few things you might not know:

Comparisons between plans should be the item on the checklist. If your new plan is cheaper, note the final difference to see if canceling will actually benefit you.
If you do decide to go forward, ask for the penalty specifics from your insurance provider. Having concrete numbers to work with will help with the bottom line for your business, so you can plan for the financial changes.
Has your new insurance firm made all the final checks? Make sure you have a 100% accurate number for your premium.
Finally, check with the next company you’re signing up with. Do they have bundles to save you money? Are they easy to work with? How is their customer service team?

When you finalize and complete these items, you will have a well-rounded idea of what canceling your insurance policy will bring.

A Note on History

Like any relationship, having a history with a company could help you in the long-run. If you’ve been with a company for several years, then you’ve built trust with them. Canceling and turning to another company could spell trouble in the long run. While the policy could be cheaper, if something were to happen (like your account falls into bad-standing) then it could prove harder to recover.

For example, if you know your broker on a first-name basis, then they might help vouch for you with an underwriter for a new policy, should you find it in turmoil. Too many claims or cancelation threats from the company could be easily solved by citing your history with the company.

person talking with agent to cancel policy — *If you like your insurance agent (and trust them), it could be worth paying a little more and staying with your current policy.*

All in all, if canceling is in your future, it needs to be done with as much (maybe even more) preparation than purchasing coverage. There are many strings attached to these policies, and you need to be aware of each of them and how they’ll affect your business in the future. It could be as simple as an added fee, but if you don’t check it out, you could be saddled with hefty premiums in the future.

EZ.Insure can give you the help you need to make the best decisions for your business. Your agent will answer any questions you have, compare different plans for you, and even sign you up when you’re ready, free of charge and without having to worry about being hounded by endless calls. To get started simply enter your zip code in the bar above, or you can speak to an agent by emailing [email protected] or calling 888-350-1890. EZ.Insure makes the entire process easy, and quick.

How to Negotiate With Your Insurance Agent

So, you’ve successfully got your business up and running, you got all of your finances in check, and now you’ve searched for a quote with EZ.Insure’s quote engine to find a new policy (group health or commercial). So–now what?

Well, you definitely can’t sit back and relax just yet. Now, it’s time for you to put on your Negotiator hat so you can get the best rates for your company. We’ve got a handy list here for exactly what you need to do (and why).

Be Hungry

woman meeting with insurance agent — *Like most conversation skills, this takes practice. Try talking with a friend to hone your edge.*

And we don’t mean for a burger.

Be hungry for answers and for results. When you take a call or travel for an office visit, bring a notepad or use a device to record important questions beforehand. Often times, people forget (or are reluctant to speak about) potential savings unless asked first. These questions involve things like:

Are there any discounts?
What are all the rates I qualify for?
Why should I purchase from you?

Come prepared to every meeting with a desire to better your business. If you come with a fighting attitude, the rest will fall into place. People respect you more when they see the conviction you have for your plans. It makes you look more attentive, reliable, and attractive when you arrive ready to resolve things.

Be Informed

Don’t just take everything at face value. Of course, insurance agents are the industry experts, after all, they do have to pass an intense exam before they get their license. But, don’t forget that they’re human too. Sometimes, it’s impossible to know absolutely everything.

People can overlook information as well. Do some digging on your own (nothing too deep, just enough to be aware of things like fees). This way, you’ll be aware of insurance rates and what the market says about them. You’ll also find it easier to talk about your terms if you know the lingo. Certain words like “premium” can mean different things in normal conversation.

close up of a suit for an insurance agent — *A bonus tip: dress to impress. You’ll feel better and look more confident.*

Be Open

If you’re shopping around for a policy, do just that–shop around. Don’t just take the first offer handed to you. If you look around at a bunch of different plans (an easy tool with EZ.Insure) then you’ll have a better idea of what you’re buying comparatively. Your rates aren’t concrete, so you have some wiggle room with negotiating a better price if you can cite another source.

Remember, even if you’ve found the perfect policy and you love your agent, you can check back regularly, about every six months. Check on your insurance package to see when it’s updated and make a habit of asking the above questions. Circumstances change in the insurance world regularly, and you don’t want to miss out on a surprise cost-saving option that just came up!

EZ.Insure was born to help you get to this point. Your agent will answer any questions you have, compare different plans for you, and even sign you up when you’re ready, free of charge and without having to worry about being hounded by endless calls. To get started simply enter your zip code in the bar above, or you can speak to an agent by emailing [email protected], or calling 888-350-1890. EZ.Insure makes the entire process easy, and quick.

Proposed Health Coverage Transparency Rule

A new transparency rule is coming, pushed forward by the current administration. It is focused on your health insurance, and how much information is revealed to you.

With health insurance, you definitely don’t want information hidden, and this goes double for fees or anything that’ll cost you money. For the most part, insurance agents work hard to make sure you’re well-informed to make decisions regarding your policy, but they can only say so much.

people sitting at a table talking about the transparency rule — *Changes are coming to teams from insurance companies to hospitals. Everyone will have to be on board.*

What the Rule Will Do

If it goes through as proposed, the rule will change the way prices are available, thus creating a better environment for people to comparison-shop for their medical work. Under this rule, both group and individual insurance markets will have to change the administration of their information. This will affect three things:

Give cost-sharing information to enrolled individuals online or in paper form. Online information will be accessed through a tool on company websites.
Disperse both in-network and out-of-network negotiated rates plus allowed amounts. These will be available in two machine-readable files.
Insurers could access “shared savings” by offering lower-cost plans and claiming the credit their enrollee’s saved by choosing the cheaper provider.

Under this rule, the disclosed information will come with seven different items:

Estimated cost-sharing liability– An averaged amount for the patient’s payment, not including premiums or otherwise. It will show cost-sharing savings or be eligible for their market plans.
Accumulated amounts– The amounts already paid (deductibles, out-of-pocket maximums, etc.)
Negotiated rates– The payments (and how much) made by the insurers, third-parties, or otherwise to in-network providers
Out-of-network allowed amounts– The maximum amount your plan/insurer covers for a specified medical expense if it’s out-of-network
Bundled payment for listed items/services- A list of covered items/services for the cost-sharing estimate. Helps with your payment
Coverage Prerequisites- A note for enrollees to see what requirements they need to meet before their expenses will be covered. Ex. step therapy
Disclosure notice– Basically anything that needs to be told to the person. Ex. an item not shown in an earlier document, differing final prices, etc.
We’ll have to learn more about our own insurance with this rule. Better visibility means more choice for the policyholder.

The outcome everyone is hoping for is that with visibility comes competition. Hospitals will have to compete with others for their price list, hopefully driving prices down. However, the hospitals fighting this rule believe that insurers will covertly come together to rig the prices. They also aren’t happy about an increase in administrative costs. Unfortunately, we won’t be seeing any changes until 2021 with most hospitals asking for extra time to prepare for the changes. We remain hopeful that this transparency rule will bring positive changes.

If you are looking to get more coverage for your company, EZ.Insure offers solutions. Your agent will answer any questions you have, compare the plans available to you, and even sign you up when you are ready, free of charge. To get started simply enter your zip code in the bar above, or you can speak to an agent by emailing [email protected], or calling 888-998-2027. EZ.Insure makes the entire process simple, easy, and quick.

Your 2020 Coinsurance Guide

Once you sign up for a health insurance plan, you are immediately expected to start monthly premium payments. Then, if you incur medical expenses such as lab work, you are expected to pay these expenses, contributing to your ‘deductible.’ A deductible is an amount you have to pay before your insurance starts paying a percentage. Then, once you are finally all caught up with your deductible, your insurance policy covers the rest of your claims, right? Well, kind of, unless your policy has a coinsurance clause.

Once your deductible is met, any insurance-covered procedure, treatment or service will result in a medical expense. This is called coinsurance. Your insurance company will pay a large portion of any bill (after your deductible is met), and you are responsible for the rest. There are different breakdowns for how the coinsurance is paid for.

Coinsurance is a great option for people needing a little extra help.

How It Breaks Down

The divisions in coinsurance policies are usually broken down into 70/30 or 80/20. What this means is the insurance company will pay 70% or 80%, and you will pay the remaining 30% or 20% out of pocket. The most common coinsurance breakdown is 80/20.

This will only apply once your deductible is met. If you have a $1500 deductible, then you must pay this off first before activating the coinsurance.

Now, let’s use an example. If your medical bill is $2,000 and you have a $1,000 deductible, then the portion of the bill that the coinsurance will apply to is $1,000. With a 20% coinsurance, you will pay $200 extra. In total, the $1,000 deductible plus the $200 remaining of the coinsurance will equate to $1,200 out of pocket.

Now if your deductible was already met and you had that same procedure that was $2,000, then you would have to pay 20% of it. The sum total of $400 out of pocket, since the insurance company paid $1,600 of the service.

Out-of-Pocket Maximum

Now, to throw a wrench into things, health insurance companies offer plans with an out of pocket maximum- but this will work in your favor if you have coinsurance. Once you reach your out of pocket maximum, then the insurance company will pay for any following services 100%.

For example, if you have a $5,000 out of pocket maximum, then the $1,000 deductible you paid goes towards that. This leaves you with only $4000 left to pay. Every 20% or 30% you pay in coinsurance goes towards your out of pocket maximum.

If you have surgery that costs $20,000, then you will have to pay a 20% coinsurance of $4,000. Once you pay that off, including the previous $1,000 deductible, then you can not be charged for anything further out of pocket. The out of pocket max will have been satisfied and the insurance company must pay any following services fully.

money saved from using coinsurance — *Think of the money you’ll save by using this insurance method–paying completely alone could be devastating.*

Because policies are renewed annually, once the new year begins, then your deductible restarts, and you will have to meet that price again. Some people have to deal with coinsurance, while others just have to pay their deductible and the insurance company will pay the rest.

In order to find a plan that meets your budget, and needs, speaking with an agent will help. They can help guide you in the best direction, and explain to you thoroughly how much everything will be. You can discuss with them coinsurance, and if you would like a plan that has one or doesn’t. To speak to one of our highly trained agents in your area call 888-350-1890, or email us at [email protected]. Or to get instant quotes, enter your zip code in the bar above. Health insurance has so many different variables. Let us make it more simple and easy for you.

Tag: insurance