What is Decent?
Decent is administering ACA compliant association health plans for self-employed individuals. Our individual plans cover 1099 contractors, freelancers, business owners, and many more. We’ve launched in Austin and are expanding quickly throughout Texas.
Our goal is to offer your clients better plans with lower premiums. Here are some things you’ll like about us:
Free primary care:
All of our plans are built around Direct Primary Care, so your clients get unlimited access to same or next day half-hour appointments, 24/7 telemedicine with their doctors, and any procedure performed by a primary care physician—all for $0 out of pocket payment.
The lowest monthly premium on any ACA-compliant $0 medical deductible Bronze plan. By a lot.
Our ACA-compliant Silver level plan covers 10% more annual medical expenses than the standard silver plan, while being priced at 20% below market rate.
Our ACA-compliant Bronze level plan has the lowest monthly premiums of any Bronze level plan offered anywhere in our service area, while still including all the benefits of direct primary care.
What you’ll love about us:
A path forward for companies looking to contribute towards their 1099s' premiums
Through our Defined Contribution, companies can make ongoing payments towards policies owned by their 1099 contractors without disrupting what they’re currently doing for their W2s. The best part? No required contribution amount or participation threshold.
Year round open enrollment
We offer year-round open enrollment so your clients can switch at any time. There’s just a brief waiting period of first of the month following 30 days.
Tax deductible premiums
Health insurance for self-employed individuals is tax deductible. We’ll help your clients' money go further.
To become a broker with Decent please fill out the form found at the bottom of this page. We’ll reach out to you with our broker agreement!
Decent plans are designed specifically for self-employed business owners, freelancers, and independent contractors (1099s) living in and around Austin, TX. Enrollees must attest to two things: that they work at least 20 hours a week and that they make at least enough from their self-employment to pay for their monthly premiums.
Yes, we offer year-round enrollment. We offer year round enrollment with a one month waiting period before the effective date (which will always be on the first of the month).
We can offer coverage to small businesses with 1099 contractors.
That’s such a good question we made a whole handout for it. Please check out Decent’s guide to broker commissions to see how your commissions will be tracked and paid.
Most of Decent’s network is in Austin. If you received a referral to go out of network, then it will be considered a covered service and would apply to your deductible and out-of-pocket limit. Referrals are always required, so you want to make sure you speak with your primary care provider before going to see a specialist, whether inside or outside of Austin, to ensure you get the best price for service.
Out of network care received without a referral may be covered in some cases after deductible has been met. There is no out-of-pocket limit for out of network services.
Urgent and Emergent care out of area will be covered in network. For example, if you were on vacation in Florida and were stung by a jellyfish scuba diving and had to go to urgent care - we have you covered.
The process is similar to seeing a specialist. Members should seek a referral from their virtual Primary Care Provider to see an in-person primary care doctor. Copay or Coinsurance costs for seeing the in-person primary care doctor would apply.
Decent’s Formulary can be found here.
Coverage is at the following rates for the following tiers:
- Pathfinder and Virtual Pathfinder Plans
- Preventive Drugs: $15 Copay
- Tier 1 : 0% after deductible
- Tier 2 : 0% after deductible
- Tier 3 : 0% after deductible
- Specialty Drugs: 0% after deductible
- Lonestar and Virtual Lonestar Plans:
- Tier 1 : $5 Copay
- Tier 2 : $25 Copay
- Tier 3 : $200 Copay
- Specialty Drugs: 50% after deductible
- Trailblazer and Virtual Trailblazer Plans
- Tier 1 : $15 Copay
- Tier 2 : $35 Copay
- Tier 3 : $100 Copay
- Specialty Drugs: $150 Copay
No, there is not a lifetime cap on any of Decent’s plans.
Coverage begins on the 1st of the month at least 31 days after the date of enrollment. For example, if you sign up on January 15th, 2020, coverage would begin March 1st, 2020.
Enrolling during the annual Open Enrollment period (November 1st through December 15th) will result in coverage beginning January 1st.
If you are on a virtual plan, you should have your preventive medicine visit virtually. Almost all of the things providers evaluate during a preventive or a wellness check have to do with checking things like your blood pressure, cholesterol, etc. and most of these do not need to be done by seeing a doctor in person.
If you are a woman and would like to have your well-woman exam performed by your OB/GYN, you may do so. We encourage you to connect your provider to your DPC, so that they may discuss your clinical results. This way your DPC can continue to work with you to quarterback your care.
Decent plans to expand to Houston and San Antonio in 2020, with Dallas / Ft. Worth and the rest of Texas being served by the end of 2021.
If a member goes to an emergency room for services the patient deems an emergency, Decent will apply the health plan ER copay or coinsurance as prescribed by the member's plan.
New providers and clinics wishing to join Decent’s network should fill out and submit this Authorization Request Form to firstname.lastname@example.org. To help speed up future payment, include an EFT Authorization Form with your request.
As a member, if your specialist is not covered and you see them, the service would be covered under out-of-network benefits (less coverage). However, we are happy to reach out to add them to our provider network! Feel free to share your doctors information with us (email@example.com), and we will have our contracting team reach out to them.
How to get appointed with Decent
Easy - simply complete the following form (or email firstname.lastname@example.org) and we’ll be reaching right out with our broker agreement. Once we get a signed copy of that in place, we’ll get you armed with everything you need to sell our plan: