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Introducing new coverage for 1099 and contract employees

The health insurance industry doesn’t have a lot of solutions for 1099 and contract employees. So when answering the question “Are you covered?,” too often the answer is a resounding, “NO.”

We understand. For a lot of businesses with contract or 1099 employees, there just aren’t the financial or administrative resources available for a traditional group insurance plan. These plans require time and an employer contribution that businesses just don’t have.

But what that means is that employees are left to purchase plans either on the federal and state exchanges or through the private marketplace. The former often having limited plan options with even more limited networks and the latter being increasingly more expensive.

Businesses with contract and 1099 employees need a product customized to fit them — one that can be provided at no cost to the company.

Try a quote for a new type of plan with ClaimLinx. Our agents take care of the application process, plan setup and the administration of the policy for employees. It’s no hassle for the business and requires no employer premium contribution.

This product is set up just like a traditional group plan, but without the financial burdens for the company. The employees cover 100% of their own premiums, but because the plan is being purchased as a group they will receive lower rates than they will find on the private individual marketplace.

With a group plan, employees will also enjoy a much larger physicians network and a more comprehensive benefit plan, including better coverage and pharmacy benefits.

The best part is once the plan is set up, there is no additional administration to worry about for the business. ClaimLinx agents take care of billing employees, paying monthly premiums, enrolling dependents and terminating any policies. All of this is included for a small fee employees pay monthly along with their premiums.

This is the perfect product for any small business with contract and 1099 employees that doesn’t currently offer a benefit plan. ClaimLinx agents are ready to start the application process and send a quote to you.

GET A QUOTE TODAY

How to file a medical claim

Note: The below information is also listed in our member packets. Download your member packet now for more information like it about your plan. 

The first step for filing a medical claim for a ClaimLinx SOS Solution Plan is to show two ID cards when you visit your medical provider:

  1. Major medical insurance company ID card as primary coverage
    • Example: Anthem, Humana, Harvard Pilgrim, Cigna, National General, etc.
  2. ClaimLinx employer funded ID card as secondary coverage

Most providers will file claims with secondary coverage. However, if the provider does not file secondary or if you receive information at your home, send any of the following items by mail or email to help@claimlinx.com to assist us in processing your claim.

  1. Major medical carrier Explanation of benefits (EOB)
    • This document is usually received about a month after a visit with a provider and has the discounted bill amount. It will come from your primary insurance coverage company (Anthem, Humana, Harvard Pilgrim, Nation General, etc.).
  2. Documentation with diagnostic coding
    • Sent by the provider, diagnostic coding explains the services performed or any diagnostic informaiton. You can also ask for this when you leave your provider’s facility.
  3. Information about the provider
    • Especially important information is the phone number to reach the physical address and billing office. You may write this on any information you send or fill out a Provider Information Form.
  4. Invoices (not statements)
    • Invoices have detailed billing information, your account number, claimant name and diagnostics. Statements do not provide any additional information for processing.

Claims are processed within 10-15 business days. You can see the full process a claim goes through once it is received at ClaimLinx. You may download an explanation of benefits for your claim once it has been processed on the member portal.

Please note that if ClaimLinx is missing any information or is waiting on requested documents, a claim will take longer to process.

If you paid up front for any services you can request a reimbursement for the services. First, you must fill out the medical expense reimbursement claim form. Then send this form with a receipt indicating you paid for the services. This can include a credit card statement, receipt from a doctor’s office, pharmacy receipt, processed beck front and back or any other proof of payment. No services can be reimbursed without this information.

What are copays, deductibles and coinsurance?

It’s not always clear exactly what your health insurance plan covers when fees and ending costs can feel like they’re hidden behind complex industry terms. So tackling understanding what they mean is important to knowing and using your benefits.

The below terms are all forms of “cost-sharing,” which is when medical services are paid by both the member and the health plan.

Copay — A fixed amount a person pays for qualifying types of services, such as office visits, specialist visits, prescription drugs or other procedures. For example, a member may have a $25 copay for an office visit with a primary care physician and a $40 copay for a specialist. All copays are fixed and detailed in the summary of benefits at the beginning of the plan and can be charged before and/or after a person has reached his or her deductible.

Deductible — The amount you pay for covered services before the insurance company begins to pay. For example, if you have a $2,000 deductible you will pay 100 percent of all eligible expenses until all the bills total $2,000. Once the deductible is paid, you will owe only any copays or remaining coinsurance for covered services. See Also: an article on embedded vs non-embedded deductibles.

Coinsurance — Paid after a person has met his or her deductible, it is a percentage of the allowed amount for services. For example, you have a coinsurance of 20% and the allowed amount for lab work is $100. If you have paid your deductible, you will owe 20% of the allowed amount of $100, or $20. If you have not paid your deductible, you owe the full amount of $100. Not all plans have coinsurance.

It’s important to be sure you understand your benefits when you receive your plan documents. All health insurance plans come with a summary of benefits, which includes informations on all copays, deductible and/or coinsurance. If you have additional questions about your plan, it’s best to contact the health insurance company directly.

You may always find contact information on your member ID card.

ClaimLinx office closed on March 30

The ClaimLinx office is closed on Friday, March 30 to celebrate the holiday with family and friends. We appreciate our clients and partners’ understanding of this time for rest and relaxation for our team.

Please plan any inquiries or need for assistance accordingly. All phone calls and emails will be returned upon our return on Monday, April 2. If you have any issues or questions, please feel free to contact us and a team member will get back as soon as possible.

We’re wishing all of our clients a very happy and rejuvenating weekend!

HSA vs HRA vs MERP

If there is one thing rising costs can provide, it’s creativity. Business owners all over are taking this opportunity to reevaluate not only from whom they purchase their health insurance, but also how they purchase it. But what are the pros and cons of all these different solutions?

First, some quick definitions:

  • HSA (Health Savings Account) – A tax-deductible savings account for medical expenses only. Contributions can be made by the plan subscriber or by an employer.
  • HRA (Health Reimbursement Arrangement or Account) – An agreement where an employer reimburses an employee for qualified medical expenses not covered on a company’s standard insurance plan.
  • MERP (Medical Expense Reimbursement Plan) – An arrangement where an employer pays providers directly for qualified medical expenses not covered on a company’s insurance plan.

All these alternatives have one big thing in common: they allow businesses to raise the deductible on their group health insurance plan. It’s the fastest way to lower that initial sticker price on the company health plan while still providing some sort of benefit.

So what’s the difference between them?

HSAs seem like the easiest way to provide cash on hand for employees. But these plans often require employees to invest in the account as well employers, and once the funds are in the account they can only be used for medical expenses. For most, estimating how much to put into the account is tricky business. Invest too much and employees feel the account is a waste, but invest too little and the account isn’t serving its purpose, which is to provide tax-free dollars to improve the plan benefit.

So perhaps you move onto an HRA – a seemingly simple way to give employees company dollars for medical services rendered. Many employees never ending up using this benefit though. For many, the filing process for reimbursement seems complicated and arduous. Others simply forget the benefit is there because of the extra processing requirements. So at the end of the day, employees are really only experiencing the high deductible health plan.

Finally moving onto a comprehensive MERP. These plans can enable employees to get back that feeling of full coverage. Because the employer is paying the provider directly for services, the employee does not have to pay for them upfront. There is still a second level of processing for the medical claims but it is not left up to the employee exclusively to sift through paperwork and requirements. All of this is done through an outside third party administrator.

All in all, there are a lot of options out there for health insurance now. That’s why it’s important you have someone to help you look at and weigh all the options.