bright spark

Hi Y'all, from sunny, Texas.

Well we have been here about 10weeks now and have just got the details of my employers benefits package. Could someone confirm if it is common for the employee to pay a weekly contribution towards the medical insurance? I knew we would have to pay for spouse and kids but expected mine to be covered by my employer. Was this just wishfull thinking?

The cover for all of us will be $163.62 a week

Thanks!

neil

Depends on the employer - my last employer covered all but about $50 a month on my most recent plan; before that (same employer) cost me and my wife about $180 a month. With my current employer we pay (just my wife and I) about $280 a month. In this case my employer does cover 100% of my coverage but only a certain percentage of the cost of family.

Bob

For a family, and half decent cover, that ain't to bad...and as to how much they'll contribute, depends on how senior and what you do, some will cover most or all of it, some will hardly cover any of it...

dbj1000

That's not unexpectedly high. I'm in Dallas, working for a company with excellent benefits, and I pay ~$50 per week for medical. I know that we pay significantly less than most employees in the area - my company covers around $250 per week of the cost.

bright spark

When the plan says "coinsurance 80% after deductible", does that mean we pay the deductible then 80% of the rest of the bill, or is it the insurance company that pays the 80%?

dbj1000

Oh hell, don't start asking me about the bullshit that insurance contracts say. I don't understand a word of them, and know nothing of my rights or coverage really.

Wait for someone else who knows their arse from their elbow (Fatbrit, perhaps?) to answer.

(but I believe it means that the insurance pays 80% after the deductible, and I think that's really pretty crappy for the money - I'm covered 100% after a $25 copay for in-network treatment)

Bob

yup, that sounds about right, and also sounds like shite cover, paying 20% of $30K for giving birth etc, or a couple grand after breaking a leg, not cheap...and another thing to look at is whether you have a roll over deductible, because last year, we had it, basically any deductible paid during the last quarter rolled over to the next, but they don't do that anymore, so if you pay your whole deductible on an accident at the end of December, you'll have to pay it all again come Jan.

Elvira

Very true. Imagine having to pay 20% of a heart bypass - or ........ cancer treatment! :scared:

But from what I hear, the OP's deal is pretty typical these days. I think we're probably lucky - employer pays around $800 per month, whereas our contribution is only $140, with no deductible as such - just co-pays.

The problem for the OP is that all this should have been negotiated before he signed on the dotted line. But if he is new to to US employment practises, how was he to know?

I don't believe in God, but if I did I'd ask him/her to bless the NHS!

bright spark

Sorry, I was mixing plans.

No deductible
$3000 max out of pocket exenses (individual) $6K family
$1million lifetime maximum
$750 copay per hosp admission
$20 copay for dr's office visit
$75 copay for ER visit

(I think it's the lifetime maximum that worries me the most)

Sorry, I know it's really boring!!

What do you think

Bob

yeah, now he's working, got bugger all bargaining power and will unlikely see any improvement now...best chance to sort anything out is at the beginning, it's all downhill after that.

Bob

that $3K/$6K is the deductible...and the hospital co-pay is a bit high, not bad on the GP co-pay, but the rest of the cover sounds crap.

dbj1000

Doesn't seem too bad to me, although you're being asked to pay quite a lot of it.

The $1M lifetime maximum isn't great, but at least it'll remind you not to work for this employer for a lifetime

scrubbedexpat099

The prospect of current covers being around for a life time is a trifle amusing, unless you are very old or die early.

bodelo

I think different States might have different laws/policies. In Ca, I had one employer that covered myself and my daughter, I had zero co pay. Then another employer had zero coverage for any of the staff. Different companies and they dont have to provide health insurance.

Oh my first job there the employer paid all of mine and 70% of my daughters, the other 30% was deducted from my paycheck (agreed by me) but it was something like $15 a month.

Angry White Pyjamas

Have you looked to see whay doctors/facilities you can use? Is it a PPO? Dont think that just because you have insurance means you can walze into any doctors or hospital for treatment and be covered.

Aldo does it cover eyes and dentist? If not you're in for an expensive time with those.