Insurance - are you happy?

[T_Anna]

I am in charge of choosing the new insurance carrier for our company. I know that I want as low a deductible as possible and that I want good out I network coverage. At the moment we have Oxford Liberty and they are ok at best. If you are decently happy with your coverage can you post or PM me?

 

Our company is in NJ but it needs to cover NYC hospitals too since many of us live over the border.

 

TIA,

T.Anna

[lfran]

Actually, I went the opposite route and it worked out great. I chose a super high deductible (actually titled the "catastrophic" plan, but the reduction in premiums was more than the higher deductible. I then put money into my Health Savings Account so that the deductible is at a tax-advantaged rate. That also boosts medical expenses, making it more likely that I would meet the IRS tax floor for medical expenses (10% AGI, starting this year). And then if, miracle of miracles, my expenses are low for a year, so was my deductible and I actually saved some money.

[T_Anna]

Thanks Ifran, need to check on catastrophic, I'm remembering something about them being illegal in NJ. Will double check.

 

T.Anna

[JoyBop]

I live in MA so I can't be of much help other than to suggest that a PPO is much better than an HMO. While PPOs can be more expensive you can see pretty much any doctor that is will accept your insurance, and in many cases get reimbursed even when they don't. ( this is conditional and based on the plans rules and is sometimes only a partial payment). With an HMO you are very limited as your PCP must refer you to a specialist that is within a limited network. It is very difficult to get approval for out of network although some have had success depending on the plan. New health care laws force insurers to provide primary and preventative care and not just catastrophic coverage. The deal with deductibles is that you can have a higher deductible in exchange for a much lower monthly rate. It's a bit of a gamble for families like ours bc we are almost certain that we will be heavily utilizing health care. You win if you have a high deductible, low monthly rates, and a healthy family that manages not to see the doctor a lot. We have a situation in our office where we went with a higher deductible plan but to offset the staffs expenses our office agreed to pay the first half of the deductible for each employee through an HRA account. That way the office still manages to save a bundle while helping defray the high risk of the larger deductible. What is a large deductible? That answer varies greatly. I was talking with a friend lately who was complaining about his deductible. I asked how much it was and he told me $500 per family. I howled!!! Our deductible is $2000 per family member with $4000 per family max and $8000 out of pocket costs which include rx copays and office copays. The office will pay the first $1000 which certainly helps but it comes out of our own pockets since we own the business. Health care for our staff is the most expensive overhead expense. But I know some people have a much higher deductible than ours so its all relative

 

My advice is to go with a PPO with a deductible that the staff can handle. If not look into HRA accounts to see if your company can share in the risk to help bring down the cost for everyone. As it works out for us, even if every employee hit the first half if their deductible we would still be saving $20k on premiums. If no one used any deductible we would be saving up to $14k more than the plan with a lower deductible. It's a numbers game for the business but as far as getting the most out if your insurance plan you want the plan that allows you to see whatever doctor you want (within reason) and a plan that is happily accepted by many. (In other words a company that pays well and timely). The other thing to look into is your insurance plans prescription formulary. These are posted online in their manuals and can be googled. Some of the better payers such as blue cross blue shield are very generous with drs and letting you see who you want, but make getting name brand drugs impossible. They make drs fill out a mountain of paperwork and require that you try at least two lower tier drugs first for many conditions. Other plans have the opposite approach.

 

We have an HMO bc we can't afford the PPO. For the most part we get to see who we like but pandas drs are not included so we loose. They are however very generous with their formulary and we get name brand drugs with out a hassle. We have Harvard pilgrim and they do not support the pandas diagnosis at all and will refuse to let me see out of network providers and won't pay for IVIG. I have been fighting appeals for months now! Their third party drs send me letters stating the literature does not support the treatments we are requesting. I have also been told by the higher ups if I had a PPO I'd be in a different boat, but we can't afford to pay the additio al $8ok it would cost the group. It's cheaper for me to cough up the cash myself.

 

Sorry to ramble, hope that's helpful.