chawkins99

I have worked for 3 different companies in the last 12 years with 3 different insurance plans and it has always worked that way. I had 3 years with United Healthcare in Florida, then 8 years with Blue Cross of Alabama and the last year back with UHC in Florida (different company and policy from the original). They have all worked that way.

You have a high-deductible plan so I guess that's the difference. My current deductible is $2,000 per person/$4,000 family. The BCBS plan was $500/$1500.

I believe rules are different by state. Hence plans are specific to each state.

Pulaski

The reason we have a high deductible plan is exactly because we were paying almost all our medical expenses even though we were on a "low deductible" plan. ...... I suspect a bigger difference is between PPO and HMO insurance. ...... Is yours perhaps an HMO plan?

Also, when it comes to the terms of insurance coverage, a big thing is what your employer sets as the terms - several people on BE have reported that their employer doesn't offer a HD plan, and in fact much of the cost and coverage of employer-provided is determined by the employer.

mrken30

My old insurance I just had to pay copays and the insurance paid a percentage from the start each year. My new insurance I have to pay the full amount until I meet the deductible. There seems to be many flavors of insurance, just to add complication to the healthcare system

Pulaski

Indeed there are, but to go back to where this branch of the discussion started, I don't think CHawkins can draw a certain conclusion from the very brief summary of the policy provided sbove by the OP, as to whether the insuree has to pay only a copay to see their doctor.

chawkins99

According to my paperwork, it's a POS (Point of Service) plan. I've never looked too deeply at the differences.

My current employer recently re-negotiated our plan and now offers a high deductible plan. As both my wife and I are diabetic, that wasn't an option so never saw the difference. I don't think they had much (if any) input on the details of the plan. They used a broker to select from UHC's standard plans.

I have only ever paid copays for office visits, prescriptions and ER visits. Diagnostics (such as x-ray, blood work, etc.) and routine screening is free.

My wife once had some skin tags removed at the doctor's office and that was classed as "outpatient surgery" and was subject to the $500 deductible.

ER trips are $350 copay then covered 100%.

chawkins99

I agree that the the OP's summary was limited, but option #3 specified "office visits 20% after deductible". Option #1 specified "$35 copayment on GP" with no mention of deductible (at least for office visits).

Other than the numbers being different, option #1 sounds very similar to my plan(s).

Pulaski

Isn't another possible interpretation though, that option #1 you are on the hook for all the cost until the deductible is reached, and thereafter only the copay, whereas with #3, you have to have to pay 20% even after the deductible is reached?

In my case the deductible is like a blanket that covers everything unless it is explicitly excluded.

chawkins99

Sure, it could be interpreted that way, but option 1 is very similar to mine (including premium) although my employer covers two thirds of the cost. My plan states (for deductible):

jenninedinburgh

Hi there,

Reading through the brochure they gave us, it's not clear on options 1 and 2 whether the deductible has to be paid first, so we'd have to call someone to find out.

We're most likely going to go with a .gov plan regardless as the rates are a bit better.

kins

Correct. I have had several insurance policies like this too.

glowie

That was exactly the reason for us to go with the high deductible. The bi weekly rates are cheaper and after meeting the deductible (BCBS does account the prescription drugs to the deductible, for my husband it's around $2400 in presc. drugs every 90 days), everything is covered 100%.
Our deductible is $5000 together, whereas my employer pays $2400 of that. Thus with one time medication for my hubby for 90 days, we're pretty much done with paying for anything healthcare related for the year.

Pulaski

Interesting. High deductible insurance works for many people, sometimes even for those who think that their medical expenses are too high to make high deductible insurance a viable option.

mrken30

I think the amount the employer contributes to the HSA makes a big difference on what people choose.

Bob

Regular annual kids health check up on the insurance rate goes for around $350...for about the 10 mins it lasts, plus cost of any jabs and tests down my way.

Bob

We've gone through a boat load of insurance companies too, in differing states. They've all worked as Pulaski has mentioned.