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Looking at getting health insurance - what an ordeal!

Looking at getting health insurance - what an ordeal!

Old Feb 19th 2009, 2:37 am
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Default Looking at getting health insurance - what an ordeal!

I have just started a new job (yay!) and which comes with various benefits (yay again!).

Unfortunately, trying to understand what is being offered in the health insurance, with the variety of options, clauses, parts and conditions has made it a daunting experience.

I haven't been able to pysche myself up to read the paperwork and also, I need to speak with someone but the HR people at the employer all assume that you have had health insurance before and they can't really help me on some of the basic aspects and stuff they think everyone already knows about.
I feel I should be able to get my head round this, since surely, it is merely choices and admin, but I just can't.

Then there is the various relationships between the employer, the insurance company, the administrator of the schemes, the actual provider of health service (in network & out), their staff., etc etc. all of whom I would come into contact with and need to know what to do and what to look out for.

Has anyone gone through this jungle recently and perhaps can help me wade through the myriad of terms, choices and what things are best to go for, if there are some general things that apply to all/most policies.

The system is run by CIGNA.

Things aren't helped by a looming deadline which if I miss, I won't be ineligible to join until Apr 2010.
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Old Feb 19th 2009, 2:43 am
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Default Re: Looking at getting health insurance - what an ordeal!

Stuff to look for:

* Monthly premium. How much you are paying every month.

* Deductible. How much you have to pay each year BEFORE the insurance starts to kick in.

* Co-pay. How much you have to pay for each visit to the doctor OR for each prescription filled.

* Your responsibility. What percentage of the total bill you will have to pay after seeking treatment, for example they may pay 90% for a pregnancy at an 'in network' hospital and only 75% at an 'out of network' place.

* Policy Maximums. How much the policy will pay over your lifetime (i.e. if you get $2 million in bills and you have $1 million max, well you can figure that out).

* Policy exemptions. What is NOT covered. Drugs, sex change, mental illness, cancer? They all vary. Best to check.

* Rules on pre-existing conditions. Are there any things that you are currently being treated for that will not be covered?

more here: http://britishexpats.com/wiki/Health_Insurance
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Old Feb 19th 2009, 2:48 am
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Default Re: Looking at getting health insurance - what an ordeal!

Originally Posted by penguinsix View Post
Stuff to look for:

* Monthly premium. How much you are paying every month.

* Deductible. How much you have to pay each year BEFORE the insurance starts to kick in.

* Co-pay. How much you have to pay for each visit to the doctor OR for each prescription filled.

* Your responsibility. What percentage of the total bill you will have to pay after seeking treatment, for example they may pay 90% for a pregnancy at an 'in network' hospital and only 75% at an 'out of network' place.

* Policy Maximums. How much the policy will pay over your lifetime (i.e. if you get $2 million in bills and you have $1 million max, well you can figure that out).

* Policy exemptions. What is NOT covered. Drugs, sex change, mental illness, cancer? They all vary. Best to check.

* Rules on pre-existing conditions. Are there any things that you are currently being treated for that will not be covered?

more here: http://britishexpats.com/wiki/Health_Insurance
Thanks for that quick reply.
Can you tell me what the difference is between co-pay and deductible?
They sound the same/similar to me.
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Old Feb 19th 2009, 7:49 am
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Default Re: Looking at getting health insurance - what an ordeal!

Originally Posted by TonkaToy View Post
Thanks for that quick reply.
Can you tell me what the difference is between co-pay and deductible?
They sound the same/similar to me.

Co-pay is the amount you pay each time you get treated. It may be a percentage, or a flat rate.

So let's say, you go for an MRI scan, and it costs $1500. Your co-pay might be $150, so you pay the first $150 and the insurance company picks up the rest.


Deductible is an annual minimum you must exceed before the insurance kicks in.

So, for instance, if all you have in one year is one visit to the doctor, and that costs $300, and your deductible is $500, then the insurance won't pay a dime.

However let's say you then have a second appointment, for another $300. That will bring you to $600, over the deductible threshold, and the insurance will kick in for any further treatment.


Basically, for most policies, you are gonna want to have some cash saved up on the side to cover these out-of-pocket costs.
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Old Feb 19th 2009, 10:00 am
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Default Re: Looking at getting health insurance - what an ordeal!

First determine if the policy is an HMO or PPO. Both are good but many people prefer PPO since you do not need a referral from your primary doctor to see a specialist. Co-pay is a set amount of money paid for each visit to the doctor and/or hospital. It is usually $20 a visit but CIGNA's might be a different amount.

If there is a deductible and many employer offered plans do not have a deductible you must use up the deductible (out of pocket cost) before the policy will kick in and pay the remainder of the hospital bills. This is usually found on privately obtained policy and I would be surprised if an employer offered plan has a deductible.

One thing to note is that if you go to a doctor and/or hospital that accepts your plan then they should accept the payment by the insurance company, plus your co-pay as payment in full and you will not be responsible for the difference between the insurance payment and the actual billed fees. Be sure to confirm this when you make an appointment for a doctor that is a member of the plan and that there will be no additional cost to you other than the co-pay amount.

Check to see if your company also offers a prescription plan which would greatly reduce your cost for meds. There is also a co-pay on this but that co-pay will definitely vary according to the meds prescribed.

Also you might be offered to join the flex spending plan which allows you to designate x amount of money per paycheck to be set aside to be reclaimed by you for out of pocket medical costs not covered by insurance. Say you know that you will need glasses this year at $350 a pair and will need to visit the doctor for an annual checkup at $20 in co-pay. So you would designate at the start of the plan to have $370 taken from your pay over the cost of the calendar year in tax free money. You then send the paid bills to the administrator of the flex spending plan and are send in turn a check for the amount you paid out of pocket. One drawback is that if you don't have expenses to cover the amount you designated you lose the money. But you need to know that even buying aspirin or tampax (for a woman) or items needed to maintain contact lens are considered out of pocket expenses so you can always find some way to meet the cost.

Simply put, you need medical insurance coverage. If the plan is less than what you would pay privately for a policy, then take it.
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Old Feb 19th 2009, 11:35 pm
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Default Re: Looking at getting health insurance - what an ordeal!

Originally Posted by Rete View Post
First determine if the policy is an HMO or PPO. Both are good but many people prefer PPO since you do not need a referral from your primary doctor to see a specialist. Co-pay is a set amount of money paid for each visit to the doctor and/or hospital. It is usually $20 a visit but CIGNA's might be a different amount.

If there is a deductible and many employer offered plans do not have a deductible you must use up the deductible (out of pocket cost) before the policy will kick in and pay the remainder of the hospital bills. This is usually found on privately obtained policy and I would be surprised if an employer offered plan has a deductible.

One thing to note is that if you go to a doctor and/or hospital that accepts your plan then they should accept the payment by the insurance company, plus your co-pay as payment in full and you will not be responsible for the difference between the insurance payment and the actual billed fees. Be sure to confirm this when you make an appointment for a doctor that is a member of the plan and that there will be no additional cost to you other than the co-pay amount.

Check to see if your company also offers a prescription plan which would greatly reduce your cost for meds. There is also a co-pay on this but that co-pay will definitely vary according to the meds prescribed.

Also you might be offered to join the flex spending plan which allows you to designate x amount of money per paycheck to be set aside to be reclaimed by you for out of pocket medical costs not covered by insurance. Say you know that you will need glasses this year at $350 a pair and will need to visit the doctor for an annual checkup at $20 in co-pay. So you would designate at the start of the plan to have $370 taken from your pay over the cost of the calendar year in tax free money. You then send the paid bills to the administrator of the flex spending plan and are send in turn a check for the amount you paid out of pocket. One drawback is that if you don't have expenses to cover the amount you designated you lose the money. But you need to know that even buying aspirin or tampax (for a woman) or items needed to maintain contact lens are considered out of pocket expenses so you can always find some way to meet the cost.

Simply put, you need medical insurance coverage. If the plan is less than what you would pay privately for a policy, then take it.

Well the plans being offered do have deductibles and are from an employer, but I still haven't fully understood these. How does this work in reality?
Does, for example, the hospital/doctor send the bill (lets say the very first bill is $500 with the deductible at $400) to the insurance company, does the insurance company then pay the $100 and sends the rest of the bill to me?

The deductibles on these plans are range from $500 to $3000 per year depending on which scheme I pick and if I have just me on them or my family (just spouse).

I have 40 pages to go through on the plans being offered JUST for the basic health insurance - I still have to look at dental things, plus things called FSA and HSA which I have no idea about what they are. These come with some kind of debit card and there's a credit card thing too!! - aaahhh make it stop!

Oh the beauty of the NHS!

Last edited by TonkaToy; Feb 19th 2009 at 11:40 pm.
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Old Feb 20th 2009, 12:02 am
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Default Re: Looking at getting health insurance - what an ordeal!

Originally Posted by TonkaToy View Post

Does, for example, the hospital/doctor send the bill (lets say the very first bill is $500 with the deductible at $400) to the insurance company, does the insurance company then pay the $100 and sends the rest of the bill to me?
More or less.



Also, don't forget that if you want to do any outdoor sports, (eg skiing or whitewater rafting) you need to make sure the plan covers these sorts of riskier activities.
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Old Feb 20th 2009, 12:32 am
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Default Re: Looking at getting health insurance - what an ordeal!

Originally Posted by TonkaToy View Post

The deductibles on these plans are range from $500 to $3000 per year depending on which scheme I pick and if I have just me on them or my family (just spouse).
Def. include your spouse! Unless she has access to her own cover. Group (employer) rates are far better than any individual plan out there.

And this is a nightmare for everyone, even those of us born n' reared here have trouble understanding it (I once went to my group's 'urgent care' clinic for an urgent matter and got in trouble for not getting a referral from my primary care doctor (who I had never seen/met). Who knew!?

Have you tried this tool at the Cigna site? http://www.cigna.com/our_plans/plan_compare.html
It looks like it might help.
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Old Feb 20th 2009, 12:45 am
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Default Re: Looking at getting health insurance - what an ordeal!

The FSA is the Flex Spending Account and the HSA is Health Savings Account and the debit card is used at the pharmacy when you get a prescription. You run it through the debit/credit card machine to pay the co-pay portion of the pharmacy bill. It is that simple.

As for the deductible, no, you pay the doctor the deductible at the time of the visit and then he will bill the insurance company for the remainder of the bill showing that you paid the deductible.

From what you are saying you have NOT chosen a plan yet and are just looking all the offerings over. That is what HR is for and they have to tell you what each plan's major details are. You can also try calling the plan's customer service department and have them run through it with you.

Last edited by Rete; Feb 20th 2009 at 12:48 am.
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Old Feb 20th 2009, 2:54 am
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Default Re: Looking at getting health insurance - what an ordeal!

Originally Posted by Rete View Post
From what you are saying you have NOT chosen a plan yet and are just looking all the offerings over. That is what HR is for and they have to tell you what each plan's major details are. You can also try calling the plan's customer service department and have them run through it with you.
The "telling" me part consisted of a group powerpoint presentation, each slide of which was shown for no more than 30 secs or so, of about 40 screens.
We have been given printed handouts but these just more or less replicate the presentation. My HR dept says if I have any questions, "to email them". This isn't good enough.
I really need to sit down with a professional, who can talk me through the entangling maze of a 8500 options/caveats/meanings/plenty of exclusions etc., etc., and who can answer my questions.

Short of that, I cannot sign up for something that I don't understand or know the consequences of. I have only a few days left to take up these plans.
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Old Feb 20th 2009, 2:56 am
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Default Re: Looking at getting health insurance - what an ordeal!

Originally Posted by Rete View Post
The FSA is the Flex Spending Account and the HSA is Health Savings Account and the debit card is used at the pharmacy when you get a prescription.
What are all these things for though?
If I am covered under the plan for medicine, why do I need a debit card?
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Old Feb 20th 2009, 3:01 am
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Default Re: Looking at getting health insurance - what an ordeal!

How much do you USE the health care system? Is it "just you" or you and family?

Google "how to choose a health insurance plan" (without the quotes) and it turns up some
decent articles.
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Old Feb 20th 2009, 3:08 am
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Default Re: Looking at getting health insurance - what an ordeal!

Originally Posted by TonkaToy View Post
What are all these things for though?
If I am covered under the plan for medicine, why do I need a debit card?
Flex spending account - pretax dollars that can be used for a variety of allowable expenses. The plan will have a list those expenses. For example, a couple of years ago I needed extensive dental work. So for that year I enrolled in a flex spending account. I had $250 per month taken out of my salary and put into the account. I then used receipts from my dentist to get reimbursed. The way it works is that the money is taken from your salary before income tax is calculated and withheld. So that $250 each month was tax-free. Flex accounts operate on a "use it or lose it" basis. I knew I was going to be able to claim the entire $3000 that year, so I had no qualms about enrolling. If I hadn't had $3000 worth of allowable expenses I would have lost anything that I hadn't claimed. Flex accounts will save you a bit of tax if you KNOW you will have certain expenses. If you aren't POSITIVE you will be able to use the benefit, don't enroll.
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Old Feb 20th 2009, 5:26 am
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Default Re: Looking at getting health insurance - what an ordeal!

Originally Posted by TonkaToy View Post
Short of that, I cannot sign up for something that I don't understand or know the consequences of. I have only a few days left to take up these plans.
They all work like this: you get ill, the insurance vanishes and you die. Or you stay healthy and the bastards make a tidy profit off you. Welcome to America.
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Old Feb 20th 2009, 9:53 am
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Default Re: Looking at getting health insurance - what an ordeal!

Originally Posted by Rete View Post
As for the deductible, no, you pay the doctor the deductible at the time of the visit and then he will bill the insurance company for the remainder of the bill showing that you paid the deductible.
.
How does the staff in the doctors/hospital know what my deductible is, how much I have left to use up etc., etc?

What if I can't remember how much, exactly, is still left on the deductible when I am at the doctor or hospital?
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