Company Group Insurance

#1
For anyone that doesn't mind sharing, I am curious to know what other company group insurance provides. Do you have to meet your deductible first before coverage kicks in or do you just make a co-pay? With my company, we have to meet our deductible first. Example... I took my son for allergy testing this week and had to pay $515 because the $750 deductible hasn't been met. Once that is met, they will cover at 80%.

I have the following:

PPO
Deductibles - $750 per family member / $1500 Family
Co-Pay $35
Specialist Co-Pay $50
Emergency Room $200

I pay $248 per month for Family - myself, Husband and 1 child.

Just wondering if this is in line with the majority of group insurance. Thanks!
 
#2
Annual Deductibles stink. The whole purpose of HMO/PPOs were to begin coverage on dollar 1. The idea is that people would be encouraged to seek attention earlier and therefore the overall treatment costs would go down. Over time, the insurance companies have diluted coverage to the point now where it is cheaper to pay cash than use insurance.

You might be surprised how much lower the cash price was for allergy testing.

Let me get off my soapbox before I go crazy.
 
#3
Our company has been pushing people to high deductible plans. They contribute to HSA and bi-weekly check is much less versus PPO option. Deductible is $4,000 per family and $8,000 out of pocket max. They cover 80% once deductible is reached. All preventive care is covered at 100% with no deductible.

If you won't hit deductible for year cash pricing is very different. DW had ultrasound earlier this year. Insurance rate $1,100 ( I would have been on hook for all as under deductible). Cash price and no insurance claim, $400. We just paid cash.
 
#4
A high deductible plan is not always so bad. I save $3,000 in premium pricing by going to a $1,500 deductible from a PPO plan. So far, I am up $1,750 in premiums for the year and have spent a little under $400 in deductible costs. Bottom line, if you are a healthy family, it is well worth the consideration going to one of these plans. Once it's spent on insurance, it's gone. And I am in this business for a living.

TexasLegal, I suggest you negotiate with the physicians office and/or let people know upfront you are on a high deductible plan and need some help with pricing.

Finally DTF, you get what you voted for. Obamacare has forced prices way up and people have responded by going to higher deductibles to keep the premiums lower. You support Obama, own it.
 
#5
I pay $248 per month for Family - myself, Husband and 1 child.

Just wondering if this is in line with the majority of group insurance. Thanks!


I can tell you your company is probably contributing approximately 3 times what you are for this policy. It may vary and be a little lower or higher, but based on your plan and industry averages, you have a very generous company. Good for you.
 

Opus

Silver Member
#6
I can tell you your company is probably contributing approximately 3 times what you are for this policy. It may vary and be a little lower or higher, but based on your plan and industry averages, you have a very generous company. Good for you.
If she worked for them last year her W2 will tell how much insurance cost.
 

bobomatic

Silver Member
#8
Not sure if we're comparing apples to oranges but it's probably pretty close. Mine is UHC:

EPO Choice
Deductibles - $200 per family member / $600 Family
Co-Pay $15
Specialist Co-Pay $25
Emergency Room $75

$292/mo. 100% after deductible
 
#10
We have deductible, then 20% co-pay. Note that this is the insurance arranged rate, not the straight bill.
So Doctor may charge $500. Insurance rate is $350. We pay off the $350.

Our deductible is high (grows every year). Many preventative items are covered 100% (physical, well baby, etc.). The last few years have been hit & miss if I hit the deductible and go to co-pay.

I did the cash option once for a CT Scan. Doc wanted me to go to one place. Our insurance info showed the rates and a lower price elsewhere. He arranged the "doctor friend" cash rate, which was lower than the lowest out of pocket. Of course it did not go against the deductible, but odds were I would be ahead that year (and was). I don't normally do this, but need to start thinking about it. The Dr offices like it because no insurance hassle (forms, delays, etc.).

We also have a "Call a Doc" for $40 program (does not count towards deductible. You can call in for regular items you would go into a clinic for, and get prescriptions. Obviously not to use for anything you need to see a doctor for. I used it for a sinus infection - had my antibiotics within an hour.

But I agree insurance is now going back to the old days where it was used for big items and it being cheaper to pay out of pocket for regular items.
 

Tooleman

Diamond Member
#12
For a family of 5, im paying like 250 a month.. We get 1000 dollars a year straight into the HSA account..

I have a 3k deductible, after that its covered 90 percent till we hit 4k out of pocket..
 
#13
Wow. I clearly am in the wrong field. Always blows my mind to see that other people have such great insurance...

Employee + child(ren) is about $350/mo, $6500 deductible, $13,000 out of pocket.
 

boiler01

Silver Member
#14
We use the husband's insurance. He pays $310/mo then our "maximum out of pocket" is $5000/$10000 and the whole PPO 80/20 thing.

If we used my insurance our premium would be around $800/mo and our out of pocket cap would be $18,000. Plus the fact that the insurance coverage wouldn't cover me seeing my oncologist, I'd need to change, and my suppressive therapy wouldn't be covered at all.

My husband used to complain about how much we had to pay until I went back to work and he was introduced to the health insurance provided to teachers in Texas. I do miss the days of 100% coverage or $2,000 max out of pocket or being able to put more than the $2500 in FSA... I could keep going. I'm alive, something denied to many, so I suck up my medical expenses and live with it.
 
#15
A high deductible plan is not always so bad. I save $3,000 in premium pricing by going to a $1,500 deductible from a PPO plan. So far, I am up $1,750 in premiums for the year and have spent a little under $400 in deductible costs. Bottom line, if you are a healthy family, it is well worth the consideration going to one of these plans. Once it's spent on insurance, it's gone. And I am in this business for a living.

TexasLegal, I suggest you negotiate with the physicians office and/or let people know upfront you are on a high deductible plan and need some help with pricing.

Finally DTF, you get what you voted for. Obamacare has forced prices way up and people have responded by going to higher deductibles to keep the premiums lower. You support Obama, own it.
Obamacare has little to do with the trend that began in the 1990s. While OCare is certainly imperfect, the concept of getting more people to pay SOMETHING is good. OCare is maybe 10% of a comprehensive healthcare reform policy that rebalances the price being charged by healthcare providers, manufacturers and pharmaceutical companies. You can see the political capital expended to just get to expanded healthcare insurance. Who wants to fix a problem when it will cost you all your political capital? H. Clinton tried to more comprehensively fix it a LONG time ago, but the power of lobbyists crushed it - couldn't get the votes (I did make a heck of a lot of money on trading the political hysteria - so thank you H).

When our shining points of light popping up all over the country (mega hospitals and medical centers) are healthcare related you can easily conclude that a disproportionate amount of of our collective resources are being spent on healthcare. It frankly has gotten too profitable to be in healthcare. It is one thing if profitability is gained through competitive advantage, better mousetrap or pricing - but this profitability has been gained by making the healthcare system so complicated that it is impossible for the consumer to competitively shop. Why can't we buy pharmaceuticals from Canada? Or better yet why are drugs being so overpriced in the US versus other nations. Why has an ice pack in the hospital been replaced with a ice "SYSTEM" that is nothing more than a fancy ice bag??

We have created a lobbyist dream with overblown complexity reinforced with insurance policies and legislation. Competing lobbyists from Pharma, AMA, Hospital systems and insurance companies on both sides of the aisle yearly get more complex rules and legislation. In complexity, there is PROFIT - and when challenged they just throw up their hands and say - I dunno.

It will not get better until the system collapses.
 

bobomatic

Silver Member
#16
Pre-existing conditions cannot be denied right? Why not just get coverage if something big does happen?
Hammer... meet nail. As far as I know, there's no provision to deny, so you're correct. I have great insurance now, but thinking about going off on my own in the next year or two. One plan is to just pay cash for what I need until anything big comes along, then sign right up. I'm not worried about paying any penalty because it's not enforceable... just make sure you rig your exemptions to not create a tax refund.

It's pretty damn sad I have to think this way as a businessman, but it is what it is. I don't like it, but the bottom line, is the bottom line.
 
#17
Hammer... meet nail. As far as I know, there's no provision to deny, so you're correct. I have great insurance now, but thinking about going off on my own in the next year or two. One plan is to just pay cash for what I need until anything big comes along, then sign right up. I'm not worried about paying any penalty because it's not enforceable... just make sure you rig your exemptions to not create a tax refund.
While I don't disagree with you at all, here in lies the brains behind Obamacare.
 
#18
Hammer... meet nail. As far as I know, there's no provision to deny, so you're correct. I have great insurance now, but thinking about going off on my own in the next year or two. One plan is to just pay cash for what I need until anything big comes along, then sign right up. I'm not worried about paying any penalty because it's not enforceable... just make sure you rig your exemptions to not create a tax refund.

It's pretty damn sad I have to think this way as a businessman, but it is what it is. I don't like it, but the bottom line, is the bottom line.
The only provision to deny is the enrollment window. It's quite possible, even likely, to run up a lot in charges in one year if something big happens.

Leonard Pitts Jr.: Blind man loses bluff on 'Obamacare'
 
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#19
Oh yeah. Ol Leonard Pitts..... he is an objective writer. No ax to grind whatsoever.

You get paid for that source even though it's not on the approved list GQ.