dunroving

My information is out of date, but from 2001-2006, the following applied to me:

No monthly premium for single employees, something like $250 pcm for married/family.

$20 co-pay per doctor visit
10% co-pay for treatment
20% co-pay for mental health treatment
$10 co-pay for generic drugs, 1-month supply
$20 co-pay for approved brand drugs
$50 or more co-pay foor brand drugs not on the approved list

Then it was something like $5,000 per annum maximum contribution from each patient (I think - so if you needed $500,000 of treatment in a year, you'd stop paying co-pays and deductibles after the first $5,000).

There was also a maximum lifetime payment, I think (i.e., after $5m or whatever it was, the insurnace comppany woouldn't pay any more). I think there was also a maximum per condition.

This was public sector (state employee) - from former colleagues, I've heard that the terms are a lot less favourable these days.

dunroving

How very un-American of you!

Derrygal

I pay $120 a month for just myself. I have a $500 deductible and then it's 80/20 plan. I just got the figures for next year and I will have a 2% increase, but that is because I am a non-smoker. The company I work for is going to charge tobacco users a lot more next year. I honestly don't know how they will do this - how will they know who smokes and who doesn't (unless they have random testing). It must be legal though (to charge smokers more) otherwise they wouldn't be able to do it. I work for a very large company, that is why my premiums are fairly low - I know some people who pay a lot more than I do.

Mallory

My hubby's company takes it upon themselves to reimburse us up to $500 per year for any prescription drug charges we have paid, after the insurance has paid.

His company also reimburses us for any doctor office co-pays that we have paid, up to $500 per year.

Nice of them!

HarryTheSpider

An interesting thread - I've been horrified to read what some of you are having to pay...

My employer provides a variety of options. The coverage is the same - what you pay each pay day simply determines the amount of deductible we pay over the year.

In a nut shell we have coverage similar to what we'd have back home with the NHS, for which I pay just under $21 every pay day for - that covers the 2 of us... and a max liability of $2300 for the year.

Here's how it breaks down...

• My employer covers me fully, and I pay $20.91 every pay day (2 weeks) for she who must be obeyed.
• I then pay a further $10 for dental cover and $5.50 for vision.
• We each have a deductible of $1150 for the current year. The employer pays 90% of all 'in network' costs and 70% of everything else. Once we've paid out our deductible, the employer pays everything else - so maximum we pay in the year for the 2 of us is $2300.
• We have $0 co-pay (yes, read that again - $0) as we have a clinic on-site, paid for by the employer - getting an appointment usually means getting the chance to see somebody the same day!
• We also have a $400 per year each, 'wellness' budget - so that covers regular checks for cholesterol for example, for various imaging, heart & major organ checks, flu shots and so on.
• Prescriptions are $8 for generic, $27 for branded, for 90 days.

I also have a medical savings account through payroll, so I have $2000 per year available through that, which I pay in to tax-free. I use that for covering the charges that my employer doesn't.

Our situation is typical - and the same broad costs apply for a family with a bunch of kids etc - it's very good. Prices have gone up by about 4% since last year. The deductible has gone up 15%.

I'll expand a little more on the culture/benefits, as I wonder if other readers here may detect a 'false economy' with those employers that expect the bulk of medical expenses to be paid by the employee...

During the recent downturn our employee satisfaction/engagement has actually increased, and during a time of rapid expansion - you normally see a significant drop in employee satisfaction when the economy hits the buffers and/or the company grows rapidly (which plays havoc with culture if not done carefully).

So although my employer doesn't pay high wages, the benefits like medical do make up for it... along with 401(k) matching, a good bonus scheme which pays out every quarter (except 1 time in the downturn when it didn't) and shares - everybody is given shares when they join and these get topped up regularly...

... as a result we have had a significant reduction in absenteeism for medical reasons, sustained for over 10 years now, and a staff turnover rate of approx 2%. Coming out of the downturn, in our first year we exceeded our previous record year for revenue by over 30% and profits by a similar amount. I believe a happy and healthy workforce is a profitable one.

We have a US friend who works elsewhere, recently had to go to A&E and was in hospital for nearly a week. When he came out, he couldn't afford the prescription meds he needed and so 2 weeks later was back in. Luckily he rents otherwise he'd have even bigger worries. We count ourselves very fortunate to have the kind of medical cover we do, and for not a lot in the grand scheme of things...

The Horticulturalist

We are a family of four, all relatively healthy so far. Two thirty something adults, two kids under 10.

We have BCBS of MS, we pay about $763 pcm, so about $9156 per annum. This is not a group plan and we have low deductibles.

*That does NOT include maternity cover, we are not planning any more children! Maternity coverage would raise that amount significantly.
*No Dental cover
*No eye cover

nun

For myself I pay $50 a month, employer pays $350 a month, no deductible, no co-insurance, $20 per doctor visit and $250 per hospitalization. $10 for generic drugs.

When I get to 55 I can retire and keep the same plan.

As I live in MA there are no pre-existing conditions and if I left work I'd be able to buy a state approved plan for $400 a month, $2k deductible, $5k out of pocket annual max, no-coinsurance.

NATIONAL-VELVET

Hi,

I've been reading this thread with interest and there are a few words with which I'm not at all familiar:-

1) Co-pay
2) In-network
3) Deductible (is this like an excess in the UK?)

I've never been to the States and confess my ignorance with regards their slang and terminology!

Cheers,

NV

robin1234

They like to use plenty of different words for "you pay."

Bob

Suggest you have a read through the wiki, it's all explained in there....along with numerous other threads if you search it out.

Welcome to BE though

Sally Redux

HarryTheSpider

AND... they can really press your guilt buttons if you need to buy a casket or anything else relating to burials of loved ones...

penguinsix

Co-pay is the amount you pay for each service or prescription. It's designed to prevent you from popping into the GP for every little scratch or bruise (generally it's like $20-$50).

In-network means that your GP has worked out an arrangement for billing and payment with an insurance company (they've done a deal). Going to them costs you less overall than going to just any random GP.

Deductible is the amount you have to pay first before insurance starts paying. Say you have a $1,000 deductible each year. You have a doctor visit that runs $300 (you pay), you then buy $600 of medicine (you pay), and then you get hit by a truck and have a $10,000 medical bill (you pay $100, thus reaching your $1,000 deductible, and the insurance pays the remaining $9,900 along with any other health care costs you have that year), more or less.

NATIONAL-VELVET

Righto, it's beginning to make sense. I'll head over to the Wikis now. Thanks.
NV