Most Common Questions

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FAQs

Why should I have a Group Coverage versus an Individual Plan?

Group coverage is the only way to get a true PPO plan in Texas. You can offer multiple plans – PPO and HMO which will be less expensive than an unsubsidized individual ACA (Affordable Care Act) plan. If you are a new Group and enroll by December 15th for coverage January 1 the normal requirement of paying 50% of the employee premium and meeting the 75% participation
requirements are waived.

What are Medi-share Plan, Faith-Based or Health Share plans?

These types of plans are not insurance and should not be considered a substitute for insurance but can be an option if you understand how they work. With these types of arrangements, you join a group and pay or
contribute a monthly amount to a plan. After your deductible is met, you submit your medical bills and are reimbursed from the funds available or through others making additional contributions to cover your bill. Many have incorporated a PPO network so you can get the discounted amount when
you have treatment. However, remember you are still responsible for the bill even if the health-share plan might reimburse you.
These arrangements also have stricter guidelines than traditional insurance companies and also on which procedures are eligible for reimbursement or cost sharing. There’s normally a lifestyle guideline
where a member agrees to live a certain way (abstain from illegal drug consumption, sex outside of marriage, tobacco use, and abuse of alcohol or prescription drugs).

What is an HSA Plan?.

HSA plans offer the lowest premium and can be a great way to build up a self-funding account for current and future medical expenses. This can be especially important if you have to
go out-of-network.
Contributions are tax deductible (as much as $5,400 for an individual and $9,750 for a family with a catch-up contribution).
Expanded eligibility: Individuals with Bronze or Catastrophic Affordable Care Act (ACA) plans are now eligible to contribute to an HSA.
In 2026, Direct Primary Care (DPC) arrangements with specific monthly fee limits will be considered qualified medical expenses, and having a DPC arrangement won't prevent HSA contributions. Also, first-dollar coverage for telehealth in HDHPs will be permanently allowed for plan years starting after December 31, 2024, making virtual care HSA-compatible.
Earnings and interest accumulate tax-free.
You own and control the funds.
HSA plans are not a use-it or-lose-it vehicle.

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What is the difference between an Occurrence vs Claims Made policy?

An “occurrence” policy covers claims arising from events occurring while the policy is in force, regardless of when the claim is first made. A “claims-made” policy covers claims reported during the policy term, provided
the event occurred after the effective date of the first policy issued. An earlier “retroactive” date may be specified in the policy to cover acts occurring prior to the original effective date.

Under a “claims-made” policy, a claim is not covered if it is made in a policy year following the occurrence unless the claims-made coverage continues in force. If it does not, run-off coverage (tail) must be purchased to cover residual claims reported later. Claims-made policies are cheaper than occurrence policies for the first several years of coverage. This is because the potential for claims builds slowly as policy years accumulate.

What is Tail Coverage?

If the dentist bought a “claims-made” policy in 2000 and did not purchase “tail” coverage when the policy expired in 2001, there would be no coverage because the claim was made after policy expiration. However, if the doctor bought an indefinite tail in 2001, then the tail
coverage policy would cover the claim.

Instead of buying a tail, a dentist may purchase “nose” (prior acts) coverage. This is done by way of a retroactive date on a new or replacement policy. A new claims-made policy with a retroactive date of June 1, 2000, would cover this claim because the retroactive date is prior to the surgery date.
Without tail or nose coverage, this claim would not be covered. Retroactive or nose coverage is useful only if a provider purchases new, continuous coverage each time he or she changes insurance
companies.

If you change insurers, be sure to take measures to prevent coverage gaps. Either purchase run-off (“tail”) coverage from the old carrier or buy prior acts (“nose”) coverage from the new one. Prior acts
or retroactive coverage is accomplished by setting the retroactive date back to the original effective date of your first policy. It’s also called retroactive coverage.

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What is an Own Occupation Definition?

Dentists should look first for a true, Specialty, Own-Occupation definition of Total Disability, for the entire Benefit Period. Under this definition, a dentist’s
benefits will not be reduced or eliminated if they work in another occupation (which could also be a different dental specialty). This means a disabled dentist is not penalized or forced to change careers because of disability. This type of definition gives the dentist the best opportunity to achieve a reasonable income again.

Should I Use my personal Disability for a Practice Loan?

Generally, No. Practice loans are often one of the biggest monthly expenses so consider a separate stand alone policy or some companies offer a special rider that can be added to your policy to specifically cover the expense.

What is General Liability for the Practice?

This coverage protects a company’s assets and pays for obligations – medical costs, for example – if someone gets hurt on your property or when there are property damages or injuries caused by you or your employees. Liability insurance also covers the cost of your legal defense.

General Liability insurance can also protect you against any liability as a tenant if you caused damage to a property that your rent, such as by fire or other covered loss.

Finally, it can also cover claims of false or misleading advertising, including libel, slander and copyright infringement.

What is a BOP Policy?

The property insurance in a business owners policy helps protect your business’ building (if you own it) and its contents against covered perils (i.e. fire, wind, hail, theft). The Business Personal Property limit (contents) should include the items you own located at your scheduled premises, such as furniture, equipment, medical supplies and computers. If you are not the building owner, but are responsible for any build-out that you installed (i.e. cabinetry, flooring, etc.), it is important to discuss this with your agent to verify that these are included in your policy limit.

What is Business Income Coverage?

This coverage is designed to protect the insured for losses of business income it sustains as a result of direct loss, damage, or destruction to insured property by a covered peril (i.e. fire, wind, hail, theft).