Ok, I am in a bit of an odd situation. I have been hired by a California corp to work from my home in Chicago. They have excellent healthcare coverage (Healthnet) with no copay required from me. However, I am in Chicago–that is out of the healthcare plan’s network. If I use their healthcare as “out of network” I pay 30% of practically every fee, with a $200 deductible, $5000 yearly out-of-pocket max. Yearly exams not covered.
Now, as they are aware that this gives me somewhat crappy coverage, they bumped up my pay $800/month so I can get supplemental insurance or get my own coverage. What I am asking you guys is:
Does anyone even sell supplementary insurance like that? How much of a giant pain in the #@# is it to deal with two insurance companies?
Should I forget about the (totally free to me, remember) healthcare from the company and get my own? (no preexisting consitions, fairly young, non smoker) Any recommendations for good insurance companies?
Go with the healthcare offered by my employer, pocket the extra cash and use it as a buffer to pay the higher fees from being “out of network”? Is $5000 really, truly, all I will be out a year even if I get cancer, AIDS, and am hit by a truck?
It would be hard to say without seeing the policy, but if the out of pocket max is $5000 and you are not required to contribute to the premium, then that really isn’t a bad deal.
The pay bump alone would cover that out of pocket cost, but is more money in your own pocket if you don’t have to use it. It comes down to, how much health care do you need? If you need very little care, then this isn’t that bad. The other thing you’ll want to make sure of, what is excluded from this plan? You mentioned that your annual checkup wasn’t covered, so that makes me think that there may be other uncovered items.
$800/mo should cover a VERY nice plan for a single healthy person. When I lived in Virginia I had an “individual” health plan through Anthem/BlueCross BlueShield which included prescription, basic dental, routine exams, and all the regular hospital stuff with manageable deductibles… it was $165/mo.
From where I sit, even if it costs you $250/mo, you’re up $550/mo in foldin’ money.
Not covered: prosthetic devices, organ and bone marrow transplants, Semi-private room for disturbed child, Hospitalization for infertility services, vasectomy, tubal ligation, infertility servcies and supplies, vision and hearing exams, immunizations, periodic health exams, visit for metal illness of a child.
I am healthy and if prodded go to the doctor once a year for a checkup, maybe a few times a year for minor ailments like ezcema. But I want to make sure my coverage means I won’t be 100k in debt if I get in a car accident–the non-covered organ transplant worries me, or does that just mean I’ll have to pay the $5000 max and then it’s covered? Or would I really have to pay for a liver transplant myself?
Costs for non-covered services do not go toward the out of pocket max. Unless they write their plan in a strange way, all you would pay for covered services is the max of $5000. Infertility services not being covered doesn’t surprise me, it usually isn’t. Yes, transplants can be expensive, but the odds are very low that you would need one.
To be honest, that doesn’t sound like bad coverage for your situation. Naturally I wouldn’t tell you what to do but if it were me, I would take the coverage they offer and pocket the pay increase.
Hm, I know the chances of a transplant are rare, but I’d hate to lose everything I have if it should happen. Maybe I will get a high deductable plan in addition to make sure I’m fully covered; that shouldn’t cost more than $200 or so.
Have you considered talking to an independent insurance agent? They can look at plans from several companies. We’ve gotten quotes and policies on life/disability and health from our local guy and been pleased with the range of options.
You should see if they have a wrap around network or a cost containment network policy. If they are a local HMO/PPO they may use a national one for just your situation. You may need to contact them directly about that, however, as more often than not, HR people don’t know all the ins and outs. And I can tell you that a lot of individual plans aren’t going to be any better than your out of network coverage. (You can’t tell I work in the insurance world, can you?)
Also, 800 dollars a month is 9600 a year, or more than your out of pocket max.
Two insurance companies is called coordination of benefits, and as far as I can tell, it is big pain for you, your company, and both carriers. And anyone else involved. There are 50,000 dollar deductible plans out there, often called catastrophic or major medical plans, although in some places you can’t get them. But the question I would ask is if I do need an organ transplant, would it be covered if I were in California. As many people have to travel 100s if not 1000s of miles to find a place to have their transplants done, anyway. The car accident would be covered (most likely) by the auto insurance companies.
There are discount plans that you can buy into to get insurance company rates that aren’t too expensive, and there are ones that only cover hear and vision. Your new company may even offer them. Mine does. It’s 8 dollars a year, for 20 to 50 percent off glasses and eye exams (we have hearing coverage).
You might want to look to see if the plan has any lifetime maximum or annual maximum coverage. It’s not that unusual to have a million dollar cap or something like that. Since it’s not unusual, I wouldn’t say that indicates a bad plan, but just something to be informed about.
The list of non-covered services actually seems a little short. Often these will specifically exclude things like cosmetic surgery, experimental treatments, and some other stuff. Make sure you are seeing the whole list. The organ transplants exclusion surprises me, since some organ transplants are fairly standard medicine.
Agree that coordination of benefits between two plans is usually worthless or worse.
If you think of the extra $800 as covering the difference between what the plan would cost you if you lived in CA, and what the plan will cost you now, it seems like you will be coming out ahead regardless, based on what you’ve posted.
You really need to talk to a broker. A high deductible plan that would cover you in case of organ transplant not related to a car accident (which would probably be covered by the auto insurance anyway) which had a $10,000 deductible/out of pocket max should cost ~$50/month if you’re under 35.
You actually have a pretty sweet deal with just the employer-provided insurance. I wouldn’t worry so much.
The cap is 5 million lifetime for PPO, out of network, and unlimited for HMO.
I only listed the stuff that was non-covered on “out of network”, but was covered in the other plans. So yeah, things like cosmetic surgery and sex changes are not covered, but I don’t forsee much need for those.
My husband can find you a guy. He doesn’t work in Illinois, but his company does. They do health and life insurance and small business benefits for self-employed or people otherwise not covered.
