Recommended health / dental insurance providers?
Jul 29th 2016, 1:09 am
#16
Concierge
Joined: Jun 2011
Location: Oakville, ON, CA
Posts: 8,320
Re: Recommended health / dental insurance providers?
Agreed.
Obviously, if your employer is paying most or all of the premiums then you would be mad not to sign up.
It is a different calculation if you are not in an employer sponsored scheme. The insurance companies are in it to make money. They expect to keep at least 35% of the premiums you pay so limit both what you can claim and the amount you can claim. If you claim more than they like they will just put up the premiums.
You can mitigate this to some extent by joining a pooled plan. The Chambers of Commerce operate a reasonable pooled plan. In a pooled plan the premiums are set on the claims experience of all the policy holders rather than your family's so you do not get penalized so much if you claim more than the insurers expected.
I have mentioned this before but it was a while ago. When I became self-employed in 2009 I had the option to continue with the extended benefits program of my ex-employer. I would have to pay the premiums myself. I looked at the cost of the premiums and what they covered and (more importantly) what they did not. I opened a savings account and deposited an amount equivalent to the premium each month. Any medical/dental expenses that would have been covered by the benefit program are paid from this account. We have had some unexpected medical costs over the years in addition to the usual visits to the dentist and the odd prescription. There is still enough in the account to buy a small car.
It may not work for everyone but it is something to consider.
Obviously, if your employer is paying most or all of the premiums then you would be mad not to sign up.
It is a different calculation if you are not in an employer sponsored scheme. The insurance companies are in it to make money. They expect to keep at least 35% of the premiums you pay so limit both what you can claim and the amount you can claim. If you claim more than they like they will just put up the premiums.
You can mitigate this to some extent by joining a pooled plan. The Chambers of Commerce operate a reasonable pooled plan. In a pooled plan the premiums are set on the claims experience of all the policy holders rather than your family's so you do not get penalized so much if you claim more than the insurers expected.
I have mentioned this before but it was a while ago. When I became self-employed in 2009 I had the option to continue with the extended benefits program of my ex-employer. I would have to pay the premiums myself. I looked at the cost of the premiums and what they covered and (more importantly) what they did not. I opened a savings account and deposited an amount equivalent to the premium each month. Any medical/dental expenses that would have been covered by the benefit program are paid from this account. We have had some unexpected medical costs over the years in addition to the usual visits to the dentist and the odd prescription. There is still enough in the account to buy a small car.
It may not work for everyone but it is something to consider.
In the case of my friend, she was up on the deal with paying premiums herself but it's because she's Type I diabetic, so she was going to have a load of claims for insulin, testing strips, and lancets. For her, it was worth it.
I am having the debate right now on whether to up my benefits package at work, which will cost me $600 extra per year. Mr Schnooks and I are going through what we expect to claim in the next year. I get more coverage on the higher plan (e.g., $500 paramedical instead of $250; for dentists, root canals etc instead of only basic cleanings; 80% of prescription drugs instead of 60%), so it's just a question of whether what we will claim makes up the $600 or not, and keeping in mind we do benefit coordination with Mr Schnooks' plan. (e.g., his coverage is also for 60% for prescription drugs, so mine going up to 80% actually doesn't matter much.)
So there are a few things to consider on whether or not it's worth it. As I said before, no one plans to be seriously sick, it's just a question of whether or not there are funds to support that eventuality.
(Another example, a coworker of mine is currently on medical leave for an autoimmune disorder. She's actually *IN* the hospital for treatment. My work has 3 levels of coverage, and hospital rooms are only covered in the highest level plan, zero coverage on the lower two levels of plan. She's been in the hospital for a month. I wonder what coverage plan she's on, and I wonder if her husband's plan has coverage. When I had Baby Schnooks, Mr Schnooks' plan covered 45% of my hospital stay. We were out of pocket the rest. Luckily I was only in one night - thankfully they admitted me at 1:30am and I was in the delivery room until 2pm the next day, didn't move into my own room until after that, so only one night charged! But still out of pocket 55% of that fee.)
