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health insurance for the self employed in massachusetts
We discussed earlier that not all members of a group are necessarily eligible under a group plan. Also, the employer may set certain eligibility requirements. Often working couples both qualify for group health insurance through their employment whereby the spouse is covered by each plan. To prevent possible abuse, special provisions are required by law in most states. This is referred to as a Coordination of Benefits Provision and allows insureds as much coverage as possible while doing away with over insurance. Receiving dual benefits constitutes fraud and is punishable by law.
While fee-for-service and managed care plans differ in important ways, in some ways they are similar. Both cover an array of medical, surgical, and hospital expenses. Most offer some coverage for prescription drugs, and some include coverage for dentists and other providers. But there are many important differences that will make one or the other form of coverage the right one for you.
Always look carefully at the description of the plans you are considering for the conditions of payment. Check with your employer, your benefits manager, or your state department of insurance to find out about laws that may regulate who is responsible for payment.
In other policies this benefit could be for non-surgical services performed by a physician whether the patient is in or out of the hospital. Once again there are limits such as $100 per visit up to 50 visits per year depending on the policy.
Some thought needs to be afforded to the possibility of “total disability.” That definition is important as it is always defined in a policy and different companies may use different definitions.
Presumptive disability may also be decided by using a loss of income test. If the earnings after disability significantly drop below pre-disability earnings by a given percentage the insured may be considered totally disabled.
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