Whatever you want to call it, I have very little belief that my company is trying to weasel out of giving us decent insurance coverage. I started this thread mostly to see if there’s something special I should take into account with the new plan. We’re in high-tech, almost all of the workforce could find another job pretty quickly were the company to not offer competitive benefits. We also compete pretty fiercely for talent; once again, cutting benefits would not be in the organization’s self-interest.
I’ve had many policies that didn’t cover standard pregnancy with the idea that pregnancy was something you opted to do (:rolleyes:).
They did, however, kick in the minute something NON-standard happened, meaning the scenario of bankruptcy probably wouldn’t happen. At least, that’s how it was explained to me.
It can make a big change if you are not covered under the insurance company’s networks as far as negotiation for fees.
For example.
A hospital decides to charge $20,000 for a widgetectomy. If you go in with no insurance and no pre-negotiation that is what will appear on your bill: owed =$20,000.
The big ass insurance company will already have negotiated with them, under the threat that if the final set of prices doesn’t make them happy they will be kicked out of the network, which is a big stick for a large market share company so if you are under Big ass insurance,you bill will be cut down to the negotiated price, say $2000, then you pay your share,deductible and co-insurance, out of that $2000.
A smaller insurance company without the same market power will likely have less negotiating power. If they are only 3% of the market, the hospital may say go ahead, kick us out of you network, we aren’t going less than $4000 for you guys. So if you had the procedure there under that insurance, your starting bill would be at $4000. Even if you have the exact same deductible and co-insurance %, you will end up paying a lot more.
And if a company goes in alone without any of the mass of an insurance plan, they may be only able to negotiate it to $10,000, which would suck.
So it does make a difference depending on how the fees are being negotiated, truly independently with only basic administration, or semi-independant but within the fee structure of an existing plan.
I’ve been told we’re still under the administration of BC/BS, and from our point of view, little has changed. That said, I’m on a high-deductible plan that covers 100% after I meet my (very reasonable) deductible. I meet my deductible in the early months of every year, so from my point of view, I don’t care what the rates are.
I don’t get the feeling that my company wants to put time or effort into doing any negotiation itself. From what’s been explained to me, I think they have some sort of deal with BC/BS where they do all the footwork on any negotiations and all that; the only change is my company covers the bills. Our health insurance cards still say “Blue Cross/Blue Shield” on them.
Is that a thing? Anyone in the insurance business know anything about how these plans are set up?
Yes - an employer can set up a self insured plan where the third party like Blue Cross performs the administrative tasks like paperwork and negotiating rates. They can act as a clearing house or intermediary for those transactions, and then send a bill to the employer who is on the hook for all fixed (administrative) and variable (claims) costs.
Employers could reduce catastrophic risk by purchasing a stop loss insurance plan that would kick in in cased of very high cost incidents. This would be akin to reinsurance. Typically employers of size can do this because they can spread the risk enough to make it worthwhile. This reduces the profit premium that a carrier normally charges. That profit is built in for the insurance company to accept the risk. If the employer is accepting the risk, then the carrier doesn’t get that profit and it could theoretically be used to lower costs.
The flaw in your reasoning is that self insurance is NOT “standard medical insurance”. If it’s done well and has a large pool to spread risk it can resemble standard medical insurance quite closely, but it’s not exactly that same thing. It’s not always done well, either.
Except health insurance doesn’t care if you go bankrupt - it only cares if 1) you paid your premium and 2) they are obligated to cover a claim.
This is how people even with top-shelf insurance can wind up bankrupt after, say, cancer - 20% of a really huge bill can still be a lot of money.
Actually, even if you have NO insurance a truly life-threatening complication will be taken care as hospitals are obligated to save your life and the life of your child.
Non-life-threatening… well, if you aren’t covered you might be out of luck and need some fund-raisers.
Many medical bankruptcies are not necessarily the result of the medical bills; the financial hardship was caused by all kinds of OTHER things that aren’t covered by any medical plan: lost wages (by the patient and/or caregivers), transportation, child care, etc.
1,200 employees does sound to me like it’s a bit small for self-insurance, but maybe they’ve crunched the numbers and determined that it’s feasible.
After I lost my job a few years ago, I had a relatively inexpensive short-term policy that explicitly said that it did not cover pregnancy-related medical expenses, period. What was the biggest complaint about it? People signed up for it, and then got pregnant, not realizing that they weren’t covered. :smack: That was the first thing the agent told me when he signed me up for it, even though I was in my late 40s at the time. ETA: PLANNED pregnancies, no less.
A while back, there was a big brouhaha about women having higher medical premiums than men. D’oh - it’s because we have higher medical expense in our 20s and 30s than men do, because of pregnancy. :rolleyes: I’m guessing that premiums were raised for men to compensate. :dubious: Nobody seems to complain that men pay higher car insurance premiums, do they? (except for the parents who are paying their teenage sons’ insurance!)
Before I went back to college, when they had the annual employee benefs signup, the presenter showed us a graph with the biggest expenditures made by their insurer. Everyone assumed that #1 would be pregnancy, because it was a young-trending company, but it wasn’t. That was 4th or 5th on the list, which except for pregnancy followed very closely the top causes of death for people under 65 - #1 by far being cardiovascular disease, followed by things like cancer, strokes, automobile accidents, and then pregnancy which women rarely die from nowadays.
I used to work at a facility that had a lot of Amish patients; they never had insurance, not even Medicare, but somehow they always paid their bills. They did their own version of Gofundme to raise the money;.
A stop loss plan would be necessary these days, because caps are now illegal.
My brother’s old employer had a $5 million lifetime cap, and there was an employee who met it. :eek: He didn’t know the person, in part because he died before my brother worked there; the man had a rare neurological disease resembling ALS and the part I especially remember was that he was on a ventilator for 11 years. That man was also able to work until less than a week before he died.
One other thing you may need to prepare for is the guilt trips. One of the ways self-insuring some companies believe if will work to save money, is that they assume people have little problem wasting insurance company money, but will think twice if it directly correlates to their job security/bonus.
The company I work at has been self-insured forever, and it’s as you describe - BC/BS administers the plan, we give a BC/BS card with a BC/BS ID number on it to our doctors, and as long as we stay in the BC/BS preferred network (which is extremely easy where I live), we get the BC/BS negotiated rates.
Assuming the company has a reinsurance program-they bought an insurance policy with a very high deductible to cover the rare huge expense, the major reason for a company to go self-insured is ERISA. This means their insurance plan is regulated only by the federal government. Depending on the state(s), this can be a big deal or just a convenience.
In my limited experience, most companies over say 200 employees self-insure. Though unless they have employment counts in the thousands they would be crazy not to have a good reinsurance plan.
I think the major advantage for most companies to self-insure is to avoid state regulation. If for no other reason than the pool of qualified insurance advisors is larger. They aren’t limited to the smaller number of advisors qualified in their particular state(s).