Health Insurance Poll

oriecat · Sep 28, 2004

We are working on our annual group insurance renewal here at work, and I am curious to find out what sort of benefits other assorted people have, and y'all are a good group of other assorted people therefore here I am...

Imagine it's January and you come down with something bad and need to see the doc to have it looked at. How much would you pay out of pocket for the office visit? Would you just pay a copay? Would you pay a percentage of the bill (co-insurance)? What percentage? Would you pay the whole thing because you hadn't met your deductible yet for the year? If so, what is your deductible?

If you're comfortable sharing this, then I would appreciate it!

Or you can PM me if you want!

Big Mike · Sep 28, 2004

Well, I'm Canadian...I don't pay out of pocket when I go to the doctor but when I see a dentist for example...I think I have to pay up front and my health plan will reimburse me the appropriate amount...something like 80%. I know that some plans have a card that you can use...then the dentist will only charge you the 20% and that's it...they charge the plan company directly.

Same with drugs, most places I have worked had a drug card so I only had to pay the 10% or 20%. My current plan does not have a card and I have to pay and get reinbursed...suposedly this saves me (and the company) some money but I would rather have the card.

I know the dental coverage has all sorts of limits. $2000 per year for minor stuff...another limit for major work...cosmetic stuff etc.

There are other coverages with limits; Chiropractor, massage therapist, etc.

I think I have coverage for eye glasses but it's only $200 every 24 months.

Hope that helps. I can break out the book if you have any specific questions.

photogoddess · Sep 28, 2004

$10 copay for a doctor's visit. No deductible. I have a pretty good plan for my employees here and an awesome insurance broker.

steve817 · Sep 28, 2004

My copay is $15. It's great insurance. When my duaghter was born 6 weeks pre-mature she spent 5 days in the NICU. I think the hospital bill was around 35K. Total cost to me at the time.....$10 dollars, which is what my copay was at the time.

Karalee · Sep 28, 2004

Last time I went to the doctor, I didnt pay a copay, in fact, Im still waiting to see how much that was.

voodoocat · Sep 28, 2004

I pay a copay of $15 for most things...
I know that we paid $1000 deductible (500 for the wife 500 for baby) to birth this child.

Alison · Sep 28, 2004

Mine is weird. Hospitals have a deductable ($300/member) up to $900 I think. Regular office visit $20. Specialist visits (and yes ladies, the GYN is considered a specialist :roll: ) $40.

gecko · Sep 28, 2004

a ob/gyn has to school further than a gp after all

Not Neve · Sep 28, 2004

Hi Mindy!

I pay a co-pay....$15 for my primary, $25 if a specialist.

In the past, I've had better insurance where I had similar co-pays but better coverage for anything like x-rays, lab work. This year my coverage for the extra tests isn't as good. And wouldn't you know, this is the year I'm diagnosed with a condition that needs constant monitoring.

So, I'm having to pay the $25 co-pay once a month, and having lab work monthly, in addition to a portion of the thyroid scan. So, I've paid a $250 deductible for the other tests, and then a co-insurance (I think it's 10%) for each date of service for the testing (whether thyroid scan or lab work or x-ray).

Sounds like Steve has the best insurance!

Not Neve · Sep 28, 2004

Oh, can K and I expect you for dinner on your visit to the Seattle area?

gecko · Sep 28, 2004

$5 copay $10 specialist
thats it

Corry · Sep 28, 2004

I hardly use my insurance, so I'm not sure about doctor visits, but my perscriptions are $5.

terri · Sep 28, 2004

I expect co-pays to go up every year, and I don't mind a five-dollar jump as long as the basic benefit package remains the same. Make sure your people understand if there are any fundamental changes: ie, to save costs, routine well care (a complete physical, no symptoms) is no longer covered, but it was in prior years and people never inspect their new booklets. Then they feel robbed when they incur an unexpected expense, and come scream at their HR people. :wink:

I expect deductibles to go up somewhat, too, if wellness/routine visits are still covered after deductible. For sick visits, an actual problem-focused visit, a co-pay should be all that is expected out of pocket. If the co-pay only gets put towards the office visit fee, and any ancillary services (like labwork) gets put towards the deductible regardless of sick/well status, make sure that gets clearly explained to your employees, too. These little things are great ways for insurance companies to not have to pay on claims, but seldom do they spell out these little "coverage changes".

The insurance I've had for years acknowledges a GYN visit as non-specialist, btw. Too many women see only their GYN for their annual checkup, never their primary care physician, for that not to have altered slightly in the market. Make sure that's spelled out for the women, as well.

Also, under the new privacy laws (HIPAA) many plans are changing from having SSN's printed on the insurance cards. Find out in advance what your company is doing in this regard, and make sure they give you a deadline if new cards are going to be issued. It's astounding how many insurance companies try to save a buck by not issuing new cards each year.

Mitica100 · Sep 28, 2004

$10 copay; $50 Emergency room; 15-25-35 for prescriptions; vision care coverage every 24 months.

dental: 100% preventive; 80% minor work; 50% major work.

oriecat · Sep 29, 2004

Wow, a lot of you have great coverage! $5 copays, who knew they still existed...

Sandy, yes, we will definitely have to meet up for dinner again, if I have to go up for meetings. I will let you know as soon as I do!

Terri, thanks for all your thoughts! Due to cost savings, we have been looking at making a big change this year. HR was all set to have to make a drastic change then once confronted with it she starts to back down. It's difficult for us to find great coverage, because we've had terrible experience the last couple years and we have 8 locations scattered in two states. So currently locations 1-4 have PPO coverage, with $1000 deductible, but office visits are covered at a $25 copay (so the deductible only kicks in for hospitalizations, surgeries, serious stuff...), then locations 5-8 have a choice between the PPO and an HMO (standard $15 copays). So we decided to maximize the group, lower premiums and distribute experience better, we probably need to go to one carrier. So the broker comes back with a plan that will cut our total increase from over 15% to under 8.5%. For locations 5-8, we would drop current PPO and add a PPO option the current HMO has, so employees could take the HMO or the PPO part. The PPO part has a $500 deductible, no office visit copays, except wellness ($30), so HR really doesn't like the loss of the first dollar benefit. BUT employees who take the PPO option can use the HMO facilities for a $20 copay. So they still have choice. But unless they want to cover that first $500 to see their doctor, then it kinda ends up driving everyone to the HMO. Then locations 1-3 would have a new regional PPO plan, with 4 $20 copays for office visits, then a $200 deductible. That plan is much better than the current plan, in my view, and it is amazingly cheaper. So I feel like HR is trying to preserve the choice of those who have it at the expense of those who never have. Sorry for the rambling and I'm sure this doesn't make any sense, but I've got these issues entrenched in my brain right now. :shock:

That's a question I should have asked, how many got to choose among health plans, or was their only one option?