[DuesTyr]

So my employer offers health insurance and I have never purchased it before so all this crap is totally new to me and I have some questions.
According to stuff I got in the mail about the coverage it says that the annual deductible is $7000 and that preventative heath care is covered 100%. So wtf does that mean?

If I go to a doctor for a check up am I going to be responsible for the entire checkup bill or does that fall under the preventative care thing?

If I needed to go back to the doctor after say I was sick would i be responsible for all of that bill too?


This stuff is so freaking confusing that it's driving me mad!

[sanddrareyk]

Contact human resources. [thumbup]
________
Lovely Wendie

[DuesTyr]

Contact human resources. [thumbup]

Did that. I got some guy from India who seemed to know less than I did :|

[joeyCanada]

It may help if you posted which company, and preferrably type of policy, it was?

[cbUDaNFRu]

So my employer offers health insurance and I have never purchased it before so all this crap is totally new to me and I have some questions.
According to stuff I got in the mail about the coverage it says that the annual deductible is $7000 and that preventative heath care is covered 100%. So wtf does that mean?

If I go to a doctor for a check up am I going to be responsible for the entire checkup bill or does that fall under the preventative care thing?

If I needed to go back to the doctor after say I was sick would i be responsible for all of that bill too?


This stuff is so freaking confusing that it's driving me mad!

$7k deductible is pretty steep.

You need to tell us:
1. what the monthly cost is
2. are there annual or lifetime payout caps (like $20k/year, $100k lifetime or something).

It could be just a standard high-deductible policy, where it's out of pocket for any non-preventive doctor visits up to $7k per year, and everything covered after that (basically a critical injury/illness insurance really)... but with checkups etc... covered.

Or it could be one of those ripoff policies where it costs $500/month, has a huge deductible, and has a payout limit that's barely higher than the deductible.

Remember, if the policy has a limit, you could only be covered in that fleeting margin between $7k and $20k.

Basically, you need A LOT more information before you can make that decision.

Just consider that $7k approaches the price of a good commercial policy for a single person.

[priceyicey]

Gnius + 1.

At your age FoodStampz, if you do not have any health issues or expensive prescriptions, I would look into getting an HSA. Usually plans with High Deductibles let you get an HSA.

HSA's are a good way to save some tax-free dollars annually that never expire.

[JeremyIV]

So my employer offers health insurance and I have never purchased it before so all this crap is totally new to me and I have some questions.
According to stuff I got in the mail about the coverage it says that the annual deductible is $7000 and that preventative heath care is covered 100%. So wtf does that mean?

If I go to a doctor for a check up am I going to be responsible for the entire checkup bill or does that fall under the preventative care thing?

If I needed to go back to the doctor after say I was sick would i be responsible for all of that bill too?


This stuff is so freaking confusing that it's driving me mad!

A 7k deductible for a single person is woefully high even with the way things are now, unless you've got a arm-length medical history with cancer and a half dozen trips to rehab on it. Mine is only 8k for two adults and two children, and our medical history is pretty terrible from an insurer's pov (cancer, long term illnesses and a godly number of broken bones - basically, insuring us has cost them a more money than we pay in)

In addition to what Gnius said, another important thing is to see what doctors your insurance is accepted at. Not much good to have insurance if you have to drive 100 miles to get to a doctor who your insurance will pay for.

[Smittoh]

Preventive would be like a periodic health exam of which you might get say 1 or 2 per year. Or say the OBGYN if your a female, just to get checked out down under.

Preventive is different then say going to the doc cause your sick, or you go see a specialist cause you have something weird on your skin. You could end up paying the entire thing, or have some kind of co-pay for this. Though if you reach your $7,000 deducible, stuff like this could become then covered.

$7,000 is a bit high. You brake a bone your going to pay for it basically. Though say you get cancer or get shot, that will cost you well over $7,000 so you pay $7,000 tops for that year. If you have to stay at a hospital overnight for any reason, $7,000 is a lot of money to pay out, but will also save you a lot of money.

How much is this policy? Does it cover drugs? Do you get coverage out of their network?

There are so many factors in a health policy, it is really hard to tell from just your minor description.


Though, go to ehealthinsurance.com to at least compare your jobs plan to other plans that are out there.



It is a lot of money, but I think that I am going to get a plan here soon for myself. A $5,000 deducible for the just in case something crazy happens to me, I don't want to be screwed for life $$ wise. I don't want to end up with a $20k, $50k, $200k bill. I'd rather have a small monthly bill to only have to pay $5,000 out of pocket which is easily handled rather then a huge burden.



Another thing that I just thought of, even if it is $7,000 deductible, once you hit that deductible, what kind of coinsurance do they offer. You want 0% at the least really cause anything after that you pay $0. If coinsurance is 15%, 20%, 30%, after the deductible, that is the rate you pay, so your still paying money after the deductible, just not as much.

[DuesTyr]

I just have the pdf so ill just post photos of what it says.

[Alkassyinhisk]

Im lucky my employer pays 100% of my medical insurance and I have no deductible AFAIK

[JeremyIV]

I just have the pdf so ill just post photos of what it says.

the good: I was thinking that 7k deductible was 'in network' so 4k/yr isn't that bad really.

the bad: all the rest. 80% after the deductible is reached is not good. Deductible kicks in after only 200$ coverage for everything, and no dental to boot. [thumbdown]


Really, the only selling point for this plan seems to be the 100% preventative care, and for that to be worthwhile for a guy, you have to be the right age to need the expensive annual checkups (prostate... and the other ones) and that is around 35-40+. Unless its become cool to have these done sooner nowadays. Or if you have a family history or high risk of heart disease, ect.

It still depends on how much you'd be paying per month though. Can't get much better for 50 or 60$ a month, but if its a lot more, its not good coverage.

[Tam04xa]

Takes a deep breath:

Your PPO benefits (in network) you have a 4k deductible that must be reached before you are able to go into what is called co-insurance. (Where the insurance starts footing some of the bill),..

for that chiro care - you get the first 200.00 paid at 100% by your plan as long as it is for a non preventive reason (like you broke your back or something and you are getting treatment to make it better). After the 200, it goes against your deductible FIRST then when you reach that 4k, you get 80% paid (or in other words you pay 20%). (I have to admit that's a strange way to word it).

As far your doctors you can choose from, you have to check their website for names and stuff.

Dependant coverage is for children or your spouse. They SHOULD have the same benefits if you chose one of those plans.

ER visits are like the chiro care, except cov at 60% if it isn't an emergency. though only after you reach your deductible.

You have no life time maximum - duh :P

Maternity, basically check ups, paid 100%, but the actual delivery you'd pay it all until you reach at least that 4k amount then you only pay 20% of it.


Mental health for your office visit (just going through the door) and your hospitalization (say you went into a suicidal spiral from depression and tried to off your self, they would admit you then that would be mental health) Paid first 200, then paid 80% (you would pay 20%) after you reach your deductible.

OP surgery (a vasectomy for example, is an OP surgical, you are in and then out), same thing first 200 then they pay 80% you pay 20% if you met your deductible.

OUT of pocket maximum is what it takes for you to hit a point where your claims are paid at 100% from insurance. 7K. So that means if you hit your 4k deductible, you then have ANOTHER 7k to hit. All those above things where it says you only pay 20% of the charges?? that 20% goes against that next level of 7k when it is hit your claims are paid *assuming they give coverage* at 100% until your ded and out of pocket max reset for your plan year.

Sorry I don't do RX at my current job so I can't really explain that well enough

Preventive care - This is things like immunizations, pap smears, mammograms, physicals, colonoscopies, prostate exams, in other words things you get done to PREVENT things from getting worse. If you got sick from mono, and you go in that is not preventive care. Paid 100% by your insurance.


Vision - it is through VSP you would have to look up them to see the benefits.

Well baby care and immunizations - when you have a child and you have to take her or him in for 6 month 8th month, 1 year, 2 year 3 year and so on check ups and shots it's paid at 100%. However this is not for if your baby gets sick, that is going to go against medical benefits.





My thoughts Overall, pretty great plan if you are the kinda person that stays healthy and cares about keeping healthy. This plan is heavily focused on keeping you healthy rather than fixing problems that have already happened.

If you do get dependants those two numbers mean individual and family amounts. So example that TM + Child is, 4k per person, but if combined you reach 7k, you BOTH move on to the next level of insurance which would be the 20% you 80% them.

Also, you are on a Plan year so that means your policy resets at a certain date and goes 1 year from that date. Example, most insurance policies run on a calendar year jan 1st to dec 31st. Your's might run from June 1st to may 31st of the following year.

Hope that helps

[DuesTyr]

Takes a deep breath:

Your PPO benefits (in network) you have a 4k deductible that must be reached before you are able to go into what is called co-insurance. (Where the insurance starts footing some of the bill),..

for that chiro care - you get the first 200.00 paid at 100% by your plan as long as it is for a non preventive reason (like you broke your back or something and you are getting treatment to make it better). After the 200, it goes against your deductible FIRST then when you reach that 4k, you get 80% paid (or in other words you pay 20%). (I have to admit that's a strange way to word it).

As far your doctors you can choose from, you have to check their website for names and stuff.

Dependant coverage is for children or your spouse. They SHOULD have the same benefits if you chose one of those plans.

ER visits are like the chiro care, except cov at 60% if it isn't an emergency. though only after you reach your deductible.

You have no life time maximum - duh :P

Maternity, basically check ups, paid 100%, but the actual delivery you'd pay it all until you reach at least that 4k amount then you only pay 20% of it.


Mental health for your office visit (just going through the door) and your hospitalization (say you went into a suicidal spiral from depression and tried to off your self, they would admit you then that would be mental health) Paid first 200, then paid 80% (you would pay 20%) after you reach your deductible.

OP surgery (a vasectomy for example, is an OP surgical, you are in and then out), same thing first 200 then they pay 80% you pay 20% if you met your deductible.

OUT of pocket maximum is what it takes for you to hit a point where your claims are paid at 100% from insurance. 7K. So that means if you hit your 4k deductible, you then have ANOTHER 7k to hit. All those above things where it says you only pay 20% of the charges?? that 20% goes against that next level of 7k when it is hit your claims are paid *assuming they give coverage* at 100% until your ded and out of pocket max reset for your plan year.

Sorry I don't do RX at my current job so I can't really explain that well enough

Preventive care - This is things like immunizations, pap smears, mammograms, physicals, colonoscopies, prostate exams, in other words things you get done to PREVENT things from getting worse. If you got sick from mono, and you go in that is not preventive care. Paid 100% by your insurance.


Vision - it is through VSP you would have to look up them to see the benefits.

Well baby care and immunizations - when you have a child and you have to take her or him in for 6 month 8th month, 1 year, 2 year 3 year and so on check ups and shots it's paid at 100%. However this is not for if your baby gets sick, that is going to go against medical benefits.





My thoughts Overall, pretty great plan if you are the kinda person that stays healthy and cares about keeping healthy. This plan is heavily focused on keeping you healthy rather than fixing problems that have already happened.

If you do get dependants those two numbers mean individual and family amounts. So example that TM + Child is, 4k per person, but if combined you reach 7k, you BOTH move on to the next level of insurance which would be the 20% you 80% them.

Also, you are on a Plan year so that means your policy resets at a certain date and goes 1 year from that date. Example, most insurance policies run on a calendar year jan 1st to dec 31st. Your's might run from June 1st to may 31st of the following year.

Hope that helps

So basiclly what it happens is the insurance starts to pay after i have already paid $7000 in doctors visits?
For instance, if i were to go to a doctor and they found something wrong with me I would have to pay for every visit out of pocket until I had paid $7,000 then they would start helping me pay for visits?

This plans runs ~$40 a month.

The dental plan is excellent though. 1.66/bi weekly and there is $50 deductible and it covers 80% of all expenses but it doesn't cover major stuff like cosmedic surgery. But it does cover like fillings, cleanings etc.

[Tam04xa]

So basiclly what it happens is the insurance starts to pay after i have already paid $7000 in doctors visits?
For instance, if i were to go to a doctor and they found something wrong with me I would have to pay for every visit out of pocket until I had paid $7,000 then they would start helping me pay for visits?

This plans runs ~$40 a month.

The dental plan is excellent though. 1.66/bi weekly and there is $50 deductible and it covers 80% of all expenses but it doesn't cover major stuff like cosmedic surgery. But it does cover like fillings, cleanings etc.

Well first you would pay upto that 4k 100% all on you (unless one of your benefits say you get something paid) Then when you reach 4k, you basically in a way are at zero again.

Then the race to that 7k is made up of what you pay 20% against.

Your insurance starts to pay after you reach 4k in deductible but if you reach another 7k after that initial 4k, then they pay EVERYTHING.

HOWEVER, you might want to ask, if your deductible is included in your out of pocket max, very very few plans I deal with with the company I work for do that, but yours might, but something that crucial would hardly be left out usually.

40.00 a month is not bad at all for such amazing routine care. one of those visits can easily take up 2-3 months worth of premium, but even on this, you will want to check for specifics. Because they might cover routine physicals, but not routine immunizations even though both are routine care it is up to the insurance company or if the company you work for paid for that benefit.

[Smittoh]

Pretty good other than the deductible. If it were me, I would want a lower deductible though. This is a plan more if your already healthy. More of something for emergencies as you will still pay a lot out of pocket a lot. Emergencies can be very expensive so I would want a lower deductible with 0% coinsurance.
Most insurances will be pretty good with preventive care just because it saves them money. Either give you a cap that they will cover like up to $300 or something, or give you cheap co-pays like $25 for each visit.


Im not sure your age, but I am 21 and can get a plan similar to that for the same price but the deductible and max out of pocket is just $7,500 (0% coinsurance) with a slightly better prescription plan. Out of network coverage is emergencies only and just $200 preventive care.
I am going to get something here soon, but I am going to pay slightly more to get $5,000 max out of pocket. I want $2,000 with some better coverage but that just starts getting too expensive for me plus I am just mainly looking for something that won't destroy my savings account and my financial future if something major happens to me.


$7,000 before insurance kicks in is a little high imo. Then after that, you have another $7,000 to spend which would equal $35,000 in total bills, then after the $35,000 they cover 100% after that.


Just shop around, see if there is anything better for you out there.

[RussellPG]

What is interesting is that our goverments has CUT the maximum deductible you can choose from something like 2.5k USD to 2k.



As far as I can tell, if you keep a large emergency fund on your bank account it would be alright.

[joeyCanada]

Problem may not be the medical costs, as such, but if you're not able to work with the same income - for example, you may be on restriced hours during the treatment or recovery.