Originally Posted by E3only

The question is, if wife falls pregnant, I have no idea of the deductibles, the co-pays etc if I am signing up for the right plan. For instance, the PPO plan we are looking at has

- Annual deductible $350/person $1,050 family maximum
- Out-of-pocket maximum $2,000/person

It also then lists out co-pays etc under categories - Office Visit, Prescription Drugs, Hospital benefits, Emergency and Other Care

So, the question is (I know a bit broad) – if my wife were to fall pregnant what would be the costs involved & what should I look for in a plan to ensure smooth 9 months for her. I am not sure what a typical pregnancy costs here.

Further my understanding is, I have to pay up first 350$ before the insurance kicks in. Then I pay co pays which will accumulate towards the 2000$ out of pocket. After that insurance covers everything? So from that logic, if the pregnancy cost is (below) at a 20% co-pay for “In-hospital physician services, surgeon, assistant surgeon 80% after annual deductible”

$5000 – I pay $350+20%*5000 = 1,350
$10,000 – 350+20%*10000 = 2,350
$20,000 – 350+20%*20,000 = 4,350 however I pay only 2,350 as Out of Pocked max at 2,000.

Is my understanding right? The other thing I need to figure out is what is covered
- Hospital room nightly rates
- Doctors fees (from the date he starts seeing here early in the pregnancy to delivery)
- Epidural injections

Originally Posted by E3only

Ok, let me throw in my question if you will.

We have access to employer health insurance fund and are unsure which insurance plan is best for us. We are thinking PPO plan but here is the deal.

Both of us no major health issues so we envisage the odd doctor visit of cold/fever etc. Both of us require Dental but I know dental is sold separately so will make sure we sign on to that.

The question is, if wife falls pregnant, I have no idea of the deductibles, the co-pays etc if I am signing up for the right plan. For instance, the PPO plan we are looking at has

- Annual deductible $350/person $1,050 family maximum
- Out-of-pocket maximum $2,000/person

It also then lists out co-pays etc under categories - Office Visit, Prescription Drugs, Hospital benefits, Emergency and Other Care

So, the question is (I know a bit broad) – if my wife were to fall pregnant what would be the costs involved & what should I look for in a plan to ensure smooth 9 months for her. I am not sure what a typical pregnancy costs here.

Further my understanding is, I have to pay up first 350$ before the insurance kicks in. Then I pay co pays which will accumulate towards the 2000$ out of pocket. After that insurance covers everything? So from that logic, if the pregnancy cost is (below) at a 20% co-pay for “In-hospital physician services, surgeon, assistant surgeon 80% after annual deductible”

$5000 – I pay $350+20%*5000 = 1,350
$10,000 – 350+20%*10000 = 2,350
$20,000 – 350+20%*20,000 = 4,350 however I pay only 2,350 as Out of Pocked max at 2,000.

Is my understanding right? The other thing I need to figure out is what is covered
- Hospital room nightly rates
- Doctors fees (from the date he starts seeing here early in the pregnancy to delivery)
- Epidural injections

Sorry I am new hear so I wanted to confirm and get my understanding right.
Cheers

Originally Posted by Duncan Roberts

Check into it. When my wife was pregnant we just had to pay a $20 copay for the entire thing (scans, doctor visits, north, room, drugs, etc) plus all her follow up appointments. It was not subject to the deductible. Pregnancy is usually treated very differently.

Originally Posted by penguinsix

Yea, ditto. To encourage pre-natal care many plans have a different policy when it comes to pregnancy. Our first child was a $20 copay for the first (of over a dozen) OB visits, and a $20 copay to get into the hospital. That was it. Second child was born under a new insurance plan and we had to pay 10% of the overall cost, which was like $1000

Originally Posted by E3only

- Room in the hospital for the 3-4 days or whatever necessary

Originally Posted by Jscl

- 10th week of pregnancy to just before delivery

Can you clarify what you mean by the above (i.e. why not from the first visit to the doctor)? If you join a medical insurance plan DURING pregnancy rather than becoming pregnant while already enrolled in the plan, some plans might go as far as to actually exclude the cost of the pregnancy from your coverage.

Originally Posted by E3only

So it would be good to call them and ask specifically how pregnancy is treated? I want clarification on costs on
- 10th week of pregnancy to just before delivery
- Scans etc during the same time
- Other expenses
- Doctor's charges for delivery
- Room in the hospital for the 3-4 days or whatever necessary

Originally Posted by Duncan Roberts

You might not be able to get clarification on the cost from the insurance company. You will be able to get clarification on how they will cover things but if you are subjected to deductibles, co-insurance, % copays and the like you will need to find out how much the services will cost from the doctors and hospital you intend to use. The costs can vary massively depending on who you use.

Originally Posted by E3only

I have asked this before but I keep getting conflicting information. Are the premiums taken out of gross salary before it's taxed? Some say only if it's > 7.5% of salary others say it's tax deductible. Similarly is 401k taken out of gross before it's taxed?

Originally Posted by Ash UK/US

Check and double check every single bill/statement you receive. Over the years I have found a fair few errors that could have cost me a lot of money.

Originally Posted by Duncan Roberts

Premiums are taken from gross salary, they are tax free. The 7.5% tax deduction is for your out of pocket expenses. So when you total up all your co-pays, non-covered things, basically everything your insurance doesn't cover, you can deduct anything over 7.5% of your income. So if you spend $10,000 on non-covered things and 7.5% of your salary would b $7,500 then you can deduct $2,500.

Originally Posted by gingerert

Absolutely correct! Before my son's Medicaid kicked in, we were constantly receiving bills for double or triple what we should have had to pay. Doctors were billing us before our insurance paid out, which meant we'd write a cheque for some unreasonable amount, fret about it for a few months, and then a refund cheque would arrive in the mail! Finally I just started double-checking all bills we received on our insurance company's website, and didn't pay a single penny until I'd had a statement from our insurance to give a final balance.

It was nice receiving those refunds though ...