Difference Between Health Insurance and Cost Share Plans for Small Business Owners and Employees / HealthChoice

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you look at health insurance right now health insurance is great to have in case you need it but it costs you so much and we usually don't need it that's the reality it's great to have in case you needed like a super catastrophic reason not because you have stitches i guess they have a broken bone it's not the right reason to have health insurance because it costs you so much more money per month and per year to cover those minor things but if you have a catastrophic things then it's better to have health insurance

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if you need it but you hope you don't need it but unfortunately costs so much so much and most of us will never need it right not really need it until maybe sometime in the future well costs are continuing to go up every month or every year they're going up 20 21 they've already said they're going to be a lot higher than this year some are projecting grew up 10 to 20 percent per month uh just just from 2020 to 2021 it's already almost doubled the last 10 years so it's crazy or it's more than doubled in some cases

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and the monthly premiums are going way up deductibles that's the newest latest thing is let's keep the monthly price down but let's put a real high deductible on it in case you don't know what a deductible it is that just means the insurance doesn't cover anything until you've paid the deductible so if you have a 5 000 deductible and you have a broken wrist and you go into emergency for your broken wrist x-ray setting emergency room fee emergency doctor you know extra mri whatever they do

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setting the cast that may be a 1800 expense well you didn't meet your five thousand dollar deductible yet so you pay all eighteen hundred bucks wait a minute i have health insurance yeah you have health insurance but you have a five thousand dollar deductible just like on cars some people have an expensive deductible on their car they get their car broken into someone steals a stereo and a computer out of it and you go file a claim and they say well you got a two thousand dollar deductible we don't cover the first two thousand what so high deductibles mean no

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coverage until you reach that deductible right so it needs makes a lower cost monthly cost but it also means no coverage until you've met your deductible so that's the trade-off and a lot of people out there have gone with high deductible plans just have something to get their monthly costs where they can afford it because premiums are so high monthly premiums are so high and of course confusion's up you all know this confusion's higher than it's ever been and uh over 30 million americans don't have health care and now 30 million have just lost their job most

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of them that had health insurance don't have health care from their employer anymore if they don't have jobs it's hard for the employer to give someone insurance when they don't even have the job so there's tens of millions of people out there uninsured and then tens of millions more who are under insured that means they've got super high deductibles so that they can keep their monthly costs manageable and we're gonna show you these things in this but what if you had an alternative which we do we have an alternative called the freedom plan and it's a from the sbi sba co-op what

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it does is dollar one coverage there's no deductible at all zero deductible so that broken risk example you go in you start getting coverage immediately uh there's lower monthly costs in many cases 20 to 30 to 40 percent lower per month so the monthly cost is lower there's no exclusions for pre-existing conditions unlike health insurance it's a ppom network the largest in the country all that means if you don't know what ppo and ppo network is preferred provider organization it just means that they've gone out and

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they've networked with a bunch of doctors and hospitals and urgent care facilities and such all over the country and they've negotiated what a broken risk costs and what a concussion cost what an mri is going to cost and so they've discounted they said if you want to be in our network which has got millions of people in it if you want to be in our network dr jones then you have to be willing to do a physical at this price you have to be willing to do a mammogram at this price you have to be willing to do stitches at

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this price and an x-ray at this price so they've already discounted the pricing okay so ppo network just means they've discounted a much lower price so if you go with a busted risk within cash price you may pay 2 400 to the emergency room you go with ppo network even if you had to cover all of it it may only be 1600 they say it's usually about 50 to 60 cheaper than cash price so you're already paying less just because you're part of a ppo network all right so that's number one

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now of course then the network covers it too at least part of it which we're going to go through with you so it's a great way to save yourself and save others money and get a lot of people are underinsured properly insured and get a lot of people who are properly covered i should say this is not insurance it's a co-op cost sharing plan um and it's all great way to get paid too so who is sba freedom plan it was created by the sba co-op what they do is they aggregate small business owners all over the country and

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combine them all into one and have a cost sharing it's called partially self-funded health care coverage so that means all these companies are paying in their monthlies and then they part of that goes into a claim fund they pay all the coverage for and my first question is that's great but what if you have a lot of claims that override how much you've all contributed well there's something called reinsurance that's purchased on every person too so it's covered so everything we commit to covering in our plan is covered doesn't matter if every employee in the company has a lot

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of claims they're all covered because number one there's that's in the claim fund but also there's reinsurance put on this so in case it goes above they're covered so the employer doesn't have to worry about this it's regulated by erisa that's an employee retirement organization it's a federally uh federal group i should say very difficult regulation but what it allows it allows us to market this in every state so this isn't a state by state compliance because it's erisa compliant it can be

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marketed in any state in the united states okay it's also aca compliant if you don't know what aca is you've probably heard of obamacare or the affordable care act which is aca part of the aca compliance is they required certain number of uh wellness visits um well-being visits like physicals and pap smears and mammograms they required all those be covered on everybody's plan every plan had to have that to be called aca compliance you got to be able to go and get a physical once a

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year you got to be able to go and get lab work once a year and you got to have a stress test at a certain age so there's different things that they wanted to make sure were covered for certain that you didn't have to pay for it was covered uh now i'll show you how the difference between us and insurance when it comes that we're aca compliant so it's aca compliant erisa compliant all cost sharing is covered through the claims of the organization and if they exceed that they're covered through reinsurance and if they're under that it's reimbursed to the employer

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so the employer can actually get money back after a year if they don't use up their whole claim fund you don't get that with insurance so that's another competitive advantage you want to add to your mind of talking to an employer is if the claim fund doesn't get used it gets reimbursed whatever is not used gets reimbursed so that's pretty cool all right so a couple of things about our plan number one there's a few plans to choose from all the plans have a individual or family option individual or family individual or

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family now each plan has cost sharing built into it so it's dollar one coverage but what a zero deductible ppo contract and savings what they do is you have a 50 50 cost share 50 50 cost share up to a certain amount and you've set that amount that's what it covers and then you could have a 20 cost share up to a certain amount and you set that amount that's what it covers and then beyond that we have 100 coverage through the catastrophic stuff so we have a 50 50 coverage

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up to a certain dollar amount which i'll show you the plan in a minute and then you could have all that means what does 50 50 coverage mean let's use that broken risk example again you have a broken wrist you go into the hospital and they're going to do surgery they're going to do x-ray set it emergency room visit all that it'd be 2200 cash price but because your ppo it's only 1600 so 1600 you show them your sba card and they say thank you we'll build your provider they build the provider the provider says hey we agreed this would be a 1600

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purchase we cover 50 david the customer will cover the other 50 so here's your 800 hospital so they take the 2200 cash price and they say hey it's ppo claim it's only going to be 1600 and we're responsible 50 of it so they pay 800 to the emergency room the other 800 would be billed to you so no deductible 50 50 coverage up to a certain point where if you go with that same broken risk with your health insurance that you're paying a lot more monthly to

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have you're going for that broken wrist it's 2200 cash but they've got a ppo as well so they get it down to 1600 but sorry david you haven't reached your deductible yet so you have to pay all 1600 we don't cover any of it so 50 50 some people go 50 50 coverage it's a lot better than zero percent coverage with a deductible right so 50 50 coverage is the plan now think about this how many how often do you actually going to file a claim

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so the monthly costs are far lower and if you never have to file a claim you saved a bunch if you have to file a claim and it's under your deductible you save the bunch because it's 50 50 coverage you don't have a deductible with us with them you have a deductible so you have zero percent coverage so you're paying more per month and you don't get any coverage until you've reached your deductible with us you're paying less a month and your 50 50 coverage starting dollar one so the low claims we price this out for 80 of the population does less than 7 500 a

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year in claims 80 percent does less than 7 500 year in claims so our basic plan is 50 50 coverage up to 7 500 which is the the 80 have less than that so that would cover 80 percent of americans just with our basic plan with our basic plan it's a lower monthly cost of 50 50 coverage right up to that okay so hopefully it answered your question we'll take questions afterward if you don't understand and as i said it's all aca compliant so it means you get all your preventative care your routine checkups

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and all that are covered 100 there's not even a copay unlike with insurance you pay a copay you get primary care doctors are covered of course urgent care visits covered x-rays cts mris all that lab and diagnostic services everything that you're used to pharmacy plan 24-hour telemedicine inpatient psychology substance abuse benefits 30 days a year are covered on that all medical services eligible for ppo network discounts so everything that you get in a ppo discount

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they're all covered insurances a lot of them exclude a lot of the stuff you just saw or they charge extra for it how would one use this plan i'm gonna go through some comparisons in a minute but how would one use the plan once someone's activated an employee or yourself they receive immediately a digital card that's eligible right now because there's a physical package being mailed to them with cards and manuals and all that but they immediately get a digital card and access to a portal all right they'll get a package sent to their home they simply go in to one of

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the doctors in the network and show the card so if i want to go in for physical first of all my primary care doctor happens to be in the network which is great uh they weren't in our original network but we expanded and showed a bigger ppo which my doctor's in so that's great um and yours probably is too it's a massive network if yours isn't you can find another one in your area it's the largest network in north america so you've got the most hospitals the most doctor coverage more than anyone else out there in the ppo world so you would simply make an appointment you go in and show your card just like

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you do with insurance you show your card if it's a wellness visit you pay nothing because they're all free there's not even a copay but if it's a specialized that broken wrist example you show your card and they say thank you they build the provider okay they build a co-op administrator the co-op administrator says okay emergency room that broken wrist is a 1600 agreed upon already agreed upon price here's your 800 bucks administrator pays their half and the other 800 will be billed to you

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again with insurance they're going to bill you all 1600 because you haven't met your co-pay yet okay so medical provider bills you for the difference you pay the difference in your coverage so how do we compare to health insurance health insurance is great for the high end for the catastrophic stuff you know where you got to be in the hospital for six months or five months and even they have limits but they got us beat above a half a million dollars in claims a year that's where they got a speed above a half a million in claims per year

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above a half a million claims per year they got a speed under that we knock their teeth out they can't hold a candle to us under half familiar most people aren't needing a half a million in coverage or more right so knowing that where do they have a speed above a half a million in claims per person per year who is that someone who gets a cancer diagnosis and needs to be in chemotherapy radiation surgery all that in under a year and it may cost eight hundred thousand we only cover up to half a million some insurances only cover up to a half

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a million you gotta look at your policy you may have a million dollar lifetime benefit or million dollar annual benefit we have 500 000 per year per uh family member uh that's the maximum we do now you got to pick that plan we've got plans that have a lot less too so where do they have a speed above a half a million per person okay if you're on that plan that's in coverage but to get a plan that does that they're charging you out the yin yang all right so they're charging a lot more too so if you never need that

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you're you're not you're not better off having that you know uh because if you don't need it you're paying a ton to have that benefit that you may never need so but just so you know that's where they're kicking our butt is above a half a million in claims we're kicking their butt up to a half million claims which most families don't do even 8 000 in claims okay so let's move forward let's look at the two let's just just you can see that kind of how health insurance versus us work and i'm not a superstar expert in this our experts handle this

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but this gives you a side-by-side comparison of our program again health insurance are required and they're mandated to give aca wellness visits all you got to do is pay a co-pay i'm looking at the left now insurance all you got to do is pay co-pay 10 15 20 we give the exact same visits but we have no co-pay so if all you do is get your physical each year and your pap smear and mammogram you don't pay anything extra with us with your with your insurance you pay a co-pay ten dollars fifteen twenty oh it's only twenty bucks well yeah give me that twenty dollar bill i'll be

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happy to grab it with us you don't even pay the twenty dollar bill okay and most people are going to use everything you see here the green screen aca wellness visits that's what most people use are the wellness visits that's why the affordable care act required them all right that's what most people need isn't it nice to know that you get it with us with no co-pay and with them they got to pay with copay sometimes there's no copay with that but usually there's a copay all right now with health insurance again you have a deductible some plans have zero deductible but most

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plans have a small deductible and other plans have a higher deductible okay this is health insurance now according to um the kaiser family foundation the and ehealth in 2018 and these have gone up the individual deductible on average in america was 4 300 individual deductible that means before you got any coverage even though you're paying monthly to have this great health insurance before

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you had any coverage the first 4 300 was not covered that was the average deductible i mean some people are paying a lot more okay the average family had an 8 300 deductible you got to write this down in your memory bank the most people you're talking to out there about their health care they're paying an 8300 they don't even have coverage until they spend 8 300 you know what's interesting that's less than the average family claims hmm less than the average family claims is what the deductible is

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that means they're not getting any coverage for the average person who has less than 8 000 claims all they get is their wellness visits the green stuff there the broken wrist they got to pay for it all the twisted ankle x-ray got to pay for the concussion got to pay for it johnny gets stitches riding his mini bike got to pay for it broken wrist broken finger playing football you had a little set you're in and out in two hours well it's 375 got to pay for it no deductible yet again they kick our butt above a half a million

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but let's keep let's keep comparing with us it's 50 50 coverage with them it's zero coverage until you met your deductible remember insurance zero coverage until you meet your deductible us it's 50 50 coverage dollar one so you do have to pay half and they pay half dollar one and we have a one plan that goes up to 7 500 bucks now insurance once you meet your deductible then they cover it but they don't cover it all they cover usually 90 they call it a 90 10

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sometimes it's an 80 20 sometimes it's a 60 40 where they'll cover 60 you cover 40 or they'll cover 90 you cover 10 usually it's not 100 covered but sometimes they do cover 100 once you met your deductible depends on which kind of plan you have okay but many times you got to cover 10 still you don't you don't get it scot-free you usually have to cover 10 but you might have a great plan where you do pay zero so but again only after your deductibles back

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now we have other plans so we have one plan it goes 50 50 up to 7 500 bucks it's an inexpensive plan and then we do a higher plan up to 20 000 where it's 50 50 up to 14 and then then you only cover 20 after that so we're getting into the woods here a little bit but just know that we have other plans that even cover more okay but here's the key most people have under 7 500 in needs per year okay so most people if you look at our basic plan on the right there we have up to 7 500 in our basic plan so

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80 percent of the people out there if they got our individual basic plan 50 50 up to 7 500 bucks they're going to be covered they're going to pay a lot less per month that's what i'm about to show you if they need more well they wouldn't be covered if they took our plan that only covered up to 7 500. if they had 60 000 in charges they'd have to pay for it above the 25 now they'd have the discount of ppo price but they'd have to pay for it okay because they only took a 7 500 option but most people it's like having auto insurance you have to have it by law

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you usually don't ever need it right hopefully you'll never need it but you got to pay for it every month hopefully you'll never need health insurance above 7 500 but you may so you know that's up to you to pick your plan and we also have an ash catastrophic plant that covers from 20 000 up to 500 000 with zero covered by you 100 covered by them zero covered by you a hundred percent covered by them zero convert value 100 covered by them it's called the ash catastrophic plan and we have several of them but we go all the way up to a half

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a million dollars that's what we talk about so what do these cost okay let's look at the individual plans first we're looking individual them versus us the average family is paying six or the average individuals paying six hundred dollars a month with a forty three hundred dollar deductible that's nationwide six hundred a month forty three hundred dollar deductible what's our basic plan 285 now that is saving you 205 i'm sorry 305 dollars a month or 3 600 bucks a year

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by being on our basic plan with no deductible so if you had four thousand dollars worth of charges you would have to pay off four thousand plus you paid the 7 200 a year for the insurance so you'd be out 11 grand if you had 4 000 in charges with us you'd be up to 285 plus half of the 4 000 you know she'd be out about half that so you can see if you're the average person under 7 500 bucks and claims we're going to kick their butt because they don't cover anything until you get to 4 300.

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okay we have another plan that'll cover up to 20 grand and it's only 365. so it's not 365 plus 285 it's 365. so even in our plan that covers up to 20 000 with no deductible we're still about 60 of the 40 off their the average insurance price and then look at this even if you go to our catastrophic plan with a half a million dollars in coverage anything above 20 grand is 100 covered by them anything above 20 grand is 100 covered

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by them anything above 20 grand 100 covered by our insurance even if you get the most expensive plan we have it only be 620 a month you need to have a half a million coverage versus the average is paying 600 a month with a thousand dollar deductible you can see why these insurance agents who helped create this plan are so excited because they're saving a lot of people money and they know most people fall into that others under 7 500 so even if you got our basic plan at 285 you're going to have most of your stuff covered but you have to decide yourself that's

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individual let's look at family real quick the average family pays 1700 bucks a month for health insurance and has an 8 352 deductible these are the averages as of 2019 they're going up in 2020 1700 bucks a month plus an 8 000 deductible that means they're paying 20 grand just in premiums so they can have their wellness visits covered 20 grand have their wellness business cover now you got to have it in case you

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have a a big need right but if you have a need and your family have eight thousand dollars and deducted before they start covering anything what's our plan cost for the basic up to 7 500 425 only not 17 14 up to twenty thousand five eighty and if you want our best plan this is for a 52 year old it's cheaper if you're younger 955 bucks per month no deductible you have 50 50 covered the max amount of pockets 14 grand in this

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example is what i'll say 14 000 and they'll cover up to half a million where with the other side you you can be out of pocket the 8 000 in deductible plus 10 percent of whatever your coverage is up to half a million that's another 50 grand so under half a million dollars we're kicking their butt above a half a million we don't have coverage so you're better off with insurance so if someone's high risk for health and they're worried about needing more than a half a million coverage they shouldn't get on our plane

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but if it's an average family who's otherwise healthy we're kicking insurance's butt right so obviously someone could go i had a friend who was in a trail bike motorcycle accident last week and he's been you know he's got all kinds of damaging things he's got to go through and it costs a lot of money it wasn't a half a million uh but things like that happen it could have been a lot worse than that right it could have been long term you could have been hospitalized for five months you know fortunately he wasn't so you know someone gets paralyzed or something like that obviously above the half a million is

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gonna it's gonna come into play so but i don't think any insurance is gonna cover that the right way that's pretty much gonna end anyone's financial ability to pay for it but these are the these are the things to be considered under half a million per claim per per uh individual this is per individual half a million two we're kicking their buck in my opinion we're kicking about you may you may feel otherwise look at the pricing there you're saving a bunch of money so just on the the family premiums alone you're at 20 grand a year plus you have an 8 300

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deductible we're a lot lower okay so hopefully this shows you when we're a better fit for an individual like my son you know he's he he goes in for a physical once a year unless he has an accident playing you know doing something in colorado he's probably never going to need anything real significant he could go pay the individual insurance plan a 700 a month with a 5 000 deductible or get on a 285 plan with us and no deductible and probably not need it get all his physicals and all that free

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and urgent care and telemedicine right so uh pretty darn you go to urgent care with your insurance it's not in your deductible you're paying with us it's only 25 bucks 25 bucks to go to urgent care with us simply get them your website once they go to your website they can learn more they can click request a quote when they click request a quote the quote is as long as they thought how many employees they have how many family plans how many individual plans whatever they put in they're going to get a quote sent back to them with all of our plans the basic plan the the plan b the second best plan and

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then the catastrophic plan so they're gonna have all those presented to them immediately through emails auto generating welcome to the sba freedom plans created by the small business agency cooperative for employers and employees employers like yourself with small businesses of two or more employees have had a difficult time attracting and retaining skilled employees over the last decade amidst a growing economy employee benefits are now the driver of marketplace movement

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for talented employees and the top benefit request is healthcare as an employer member of the sba co-op an employer can purchase their own partially self-funded erisa employer medical benefits plan for its employees and their dependents in all 50 states it is well known that high premiums and high deductibles and medical benefits programs nationwide create a struggle for employers to establish a comprehensive company healthcare plan

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that contains affordable premiums while maintaining low or zero deductibles the small business agency cooperative sponsors comprehensive medical benefits plans regulated by erisa that includes the features and benefits that you as an employer or employee would expect statistics indicate that productivity rises and absenteeism is reduced when employee stress is lessened if an employer offers wellness and comprehensive

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benefits employees can stay healthy and working while also providing for family health care at home this is at top of mind for employees in addition to these listed benefits these medical benefits plans include the minimum essential coverage under the affordable care act for preventative and wellness care the sba co-op freedom plans comprehensive health care coverage for your everyday needs include low premiums zero deductibles with first dollar coverage low

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individual and family maximum out of pocket on base plans up to the annual coverage limit no deductible and co-insurance on buy-out plan additions additional buy-up maximums for catastrophic plans one hundred and fifty thousand two hundred fifty thousand and five hundred thousand no medical underwriting no pre-existing condition exclusions on base plans no waiting periods on base plans national ppo network dental and vision discount plan through

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network providers includes lasik surgery there are no surprises here an erisa regulated group health care plan is employment based and provides coverage for all base plans these plans include primary care and specialist office visits 24 7 365 physician access by 24-hour virtual clinic at no cost prescription drugs wellness and preventative benefits included inpatient outpatient hospitalization emergency room and ambulance

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medical imaging and x-ray urgent care facility behavioral health care chiropractic limited and in network and durable medical equipment a unique feature of a level funded partially self-funded plan under erisa is the return of your unused claims allowing you to reinvest these dollars toward employees reducing the impact of contributions while effectively managing your health care costs employers can easily begin a medical benefits plan

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and enroll any time of the year as an option employers may choose to retain an existing carrier plan placing the sba co-op health care plans alongside as an additional affordable employee selection if you would like to learn more about the different benefit options please complete the employer group information form by selecting get a quote we will furnish a quote plus benefit details for you and your staff within 48 hours thank you for your time we look forward

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Difference Between Health Insurance and Cost Share Plans for Small Business Owners and Employees

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