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Health Insurance Question

Health Insurance Question

Old Jan 1st 2010, 10:17 pm
  #1  
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Default Health Insurance Question

I am starting a new job on the 11th Jan following a lay off. When I received my insurance details for my previous job I didn't take to much notice, I just paid the fees and the co pay. Having received the insurance details for my new position I have a couple of questions that somebody will probably be able to answer really quickly, the details for the insurance plan are below, followed by the questions

Deductible $500/$1,250
Out of Pocket Max $1,500/$3,750
Coinsurance Benefit 90%

1) I am unsure what the deductible counts towards. Does this deductable mean I will have to pay the first $1250 for ANY health care, even GP visits, etc or does it just count if me or somebody in my family gets taken to hospital. I don't recall ANY deductable in my last plan (i just paid the copay and was never asked to pay any more), although none of us ever got taken to hospital?
2) Out of pocket Max - what is this
3) CoInsurance Benefit - Can somebody clarify what this is.

Thanks, I feel stupid asking these questions having been in the US for a couple of years but as I say I didn't take much notice of my previous plan, I just payed the premiums
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Old Jan 1st 2010, 11:47 pm
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Default Re: Health Insurance Question

For ours the deductible is about 20% of each doctor visit so long as we use a doctor who is part of the network (a preferred provider) if we go outside network we pay 100% of the visits not sure till how long we never strayed
The max out of pocket for us is once we have put out that much they cover the whole family 100% for the rest of the calender year.
We reached max in Summer and had everyone covered 100 this year till just yesterday.
No idea what #3 is
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Old Jan 2nd 2010, 1:06 am
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Default Re: Health Insurance Question

Coinsurance means that they pay 90% of the bill, you pay 10%. So if the bill is $2,000, you are responsible for $200 and they will pay $1,800. However, with the deductible and max, it's a bit more complicated.

Costs $1-$500 (deductible). Out of your pocket. $500
Costs $500-$10,500, they pay 90% you pay 10%, or about $1000
Costs of $10,500+. They pay as you have reached your max

Or something like that (please don't quote me--have your HR run you through the math). But it should be something like that.
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Old Jan 2nd 2010, 1:31 am
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Default Re: Health Insurance Question

Thanks for the answers. Is it usual to have an insurance plan with no deductable, I'm confused why I never got hit with a deductable in my previous employment?
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Old Jan 2nd 2010, 3:15 am
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Default Re: Health Insurance Question

Originally Posted by Jmaster911 View Post
Thanks for the answers. Is it usual to have an insurance plan with no deductable, I'm confused why I never got hit with a deductable in my previous employment?
Every health insurance plan is different. Two people working at different jobs but have coverage through the same insurance could have two completely different types of coverage.
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Old Jan 2nd 2010, 4:10 am
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Default Re: Health Insurance Question

It looks like you have a very good plan with a high coinsurance (probably for in network doctors) and low maximum out of pocket expense. Therefore I suspect that there is more to your plan other than stated.

Normally very good plans, like yours, will indicate a co-pay of a certain amount for doctors visits (eg. $15 co-pay). When it is indicated as such, the deductable usually does not apply. Also generally the deductable does not apply to prescription drug benefits. The deductable may also not apply to lab work and sometimes the lab work is paid 100% by the insurance company.

Check the benefits of the plan to see when the deductable may or may not apply.
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Old Jan 2nd 2010, 3:06 pm
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Default Re: Health Insurance Question

Originally Posted by Michael View Post
It looks like you have a very good plan with a high coinsurance (probably for in network doctors) and low maximum out of pocket expense. Therefore I suspect that there is more to your plan other than stated.

Normally very good plans, like yours, will indicate a co-pay of a certain amount for doctors visits (eg. $15 co-pay). When it is indicated as such, the deductable usually does not apply. Also generally the deductable does not apply to prescription drug benefits. The deductable may also not apply to lab work and sometimes the lab work is paid 100% by the insurance company.

Check the benefits of the plan to see when the deductable may or may not apply.
Thanks Michael, that makes a lot more sence. My co-pays are around $25, with a paycheck deduction of $325 for a family. So as you say it looks like a good plan.
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Old Jan 2nd 2010, 5:58 pm
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Default Re: Health Insurance Question

They all look like coverage for non-office type stuff (ER visits, surgery, some diagnostic testing, etc), your co-pay should be what applies to all your general office visits. You should have a completely separate schedule for prescription coverage but it should have out of pocket max and co-pay amounts, possibly a deductible as well but that's not all that common for a prescription plan.
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Old Jan 2nd 2010, 6:03 pm
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Default Re: Health Insurance Question

Originally Posted by Jmaster911 View Post
Thanks Michael, that makes a lot more sence. My co-pays are around $25, with a paycheck deduction of $325 for a family. So as you say it looks like a good plan.

Michael has no way of knowing if it is a good plan or not. The details you have given make it seem like an acceptable plan. The co-pay is the same as ours and the premium is less than what I would be charged monthly for a family plan from my firm but far more than would I will be paying (don't pay anything at the moment) when hubby retires in July.

But .... are you going to decline it if you decide you don't think it is or someone here thinks it isn't? Are you prepared to fund your own private healthcare policy.
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Old Jan 2nd 2010, 7:18 pm
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Default Re: Health Insurance Question

Originally Posted by Rete View Post
Michael has no way of knowing if it is a good plan or not. The details you have given make it seem like an acceptable plan. The co-pay is the same as ours and the premium is less than what I would be charged monthly for a family plan from my firm but far more than would I will be paying (don't pay anything at the moment) when hubby retires in July.

But .... are you going to decline it if you decide you don't think it is or someone here thinks it isn't? Are you prepared to fund your own private healthcare policy.
Its not a monthly charge, its bi-weekly and compared to my last plan its very expensive with from what I can make out about the same ben's. Will I look at other options, of course. Right now anything is better than the insurance I have - which is nothing!!
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Old Jan 2nd 2010, 8:41 pm
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Default Re: Health Insurance Question

Originally Posted by Jmaster911 View Post
Thanks for the answers. Is it usual to have an insurance plan with no deductable, I'm confused why I never got hit with a deductable in my previous employment?
depends, some might have no deductible for certain things like regular GP visits, but have one for hospital visits etc.

the 500/1250 split thing is also probably deductible for in and out of local network.

It's all in the small print.
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Old Jan 3rd 2010, 5:28 pm
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Default Re: Health Insurance Question

Why don't you give HR a call this week and ask the benefits administrator to break it down for you? If you ask in a friendly way and explain that you're unfamiliar with the system, they may go easy on you and explain it so even I could understand.
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Old Jan 4th 2010, 3:06 pm
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Default Re: Health Insurance Question

Originally Posted by meauxna View Post
Why don't you give HR a call this week and ask the benefits administrator to break it down for you? If you ask in a friendly way and explain that you're unfamiliar with the system, they may go easy on you and explain it so even I could understand.
I must take exception to your post - its not nice of you to advise him to do this without due warning.

He is best prepared to enter the HR den with a string of garlic, a silver cross of some size and possibly a few sharp-pointy wooden things.

Its an unfortunate and common misconception that HR "people" are just that.
Its because of their use of the word "human", you see.

They are, infact, undead creatures from Hell spawned and sent by Satan.

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Old Jan 4th 2010, 7:58 pm
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Default Re: Health Insurance Question

Originally Posted by meauxna View Post
Why don't you give HR a call this week and ask the benefits administrator to break it down for you? If you ask in a friendly way and explain that you're unfamiliar with the system, they may go easy on you and explain it so even I could understand.
I believe this is the best way out. (seek your HR for advice)
I used to work in Ace Insurance, & I have a little knowledge about insurance, but still, I realise that different company offers different coverage.
It also depends on what your company opt for.
Some insurance coverage comes without deductable or copayment, provided that the premium payable is higher.
I have not come across the term Max payout.
However, in Singapore, deductable means any amount lesser than the stated deductable amount, you will have to pay.(up to the stated amount), and whatever outstanding, you have to co-pay, means they pay a % and you pay a %.
therefore, I believe what your company plan offers here is....
If the bill is $10000, first, you have to pay $500(deductable) plus out of the remaining $9500, they will pay 90% of the bill & you pay 10% of the bill.
Which means to say, you will have to pay 10% of $9500 = $950.
But with the max pay out at $1500, after paying the $500 deductable, your co-payment is $1000 max. anything more than that, you will pay $1500 max. & the insurance company pay for the rest.
Therefore, if your bill is $20000, you will have to pay $500(deductable) plus 10% of rest of the bill which is supposely 10% of $19500 which works out to be $1950 (co-payment), altogether = $2450, but instead, you just pay $1500.
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Old Jan 4th 2010, 9:34 pm
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Default Re: Health Insurance Question

Originally Posted by Xebedee View Post
I must take exception to your post - its not nice of you to advise him to do this without due warning.

He is best prepared to enter the HR den with a string of garlic, a silver cross of some size and possibly a few sharp-pointy wooden things.

Its an unfortunate and common misconception that HR "people" are just that.
Its because of their use of the word "human", you see.

They are, infact, undead creatures from Hell spawned and sent by Satan.

It is a reason they are called the "Lady Sciences"
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