Health Insurance Questions

Discussion in 'The Watercooler' started by JJJ, Jun 16, 2010.

  1. JJJ

    JJJ Active Member

    husband's company's open enrollment period is starting. The agent told husband that it would be cheaper for us to purchase an individual policy just for us instead of being part of the group coverage. husband is one of the youngest employees and we don't need maternity coverage and neither of us are smokers,nor have had cancer, etc. so we are a much lower risk group than his co-workers.

    The clear benefits:
    *lower premium for same health insurance plan
    *able to add dental coverage and still have lower premium

    The agent says none but I think there must be.

    Anyone go through this or work in health insurance?
  2. susiestar

    susiestar Roll With It

    I would INSIST on exact numbers for your costs, copays, coinsurance, deductibles, etc... Also look for the lifetime caps on what they will pay, on your out of pocket, etc...

    Make SURE that the indiv policy will go through and be fully approved before the open enrollment closes. One of husband's coworkers did this and the policy was not totally approved before enrollment closed. They hit a snag with the underwriters saying that certain things couldn't be covered and ended up with no coverage for several months and then having to pay a lot more because that coverage gap made some things pre-existing. It is my understanding that as long as you are continuously covered by health insurance from any company then your problems cannot be considered co-existing problems. Be SURE to double check this.

    Ask for the details on mental health coverage. Many companies have these services managed by a separate dept or even separate arm of their company. It can effect what is covered, how easy it is to find a qualified provider, and many other things.

    Be SURE to check pharmacy benefits. Compare them to what you have now and compare the formularies. Some companies have very limited formularies and do not cover many medications, esp psychiatric medications. Go through the family medication list and price it with each plan AND with the $4 list at Walmart and other stores.

    What will happen if Kanga gets pregnant? Will you have to cover that out of pocket? Could you add the baby to your plan once it was born? Would alternatives be covered (not sure if you could/would consider them, but you need to think about it)? NO birth control is 100% except abstinence and with the new Residential Treatment Center (RTC) situation that will not be an easy thing to enforce. Some people's body chemistry is given enough of a boost to get pregnant when birth control is added. Girls who want to become pregnant can always find a way to make their birth control less effective also.

    Look to see how eye problems are handled. Some policies cover opthalmologists (md's) for problems not related to near and far sightedness. Some do not cover this at all. Can you add vision insurance to make the cost of exams cheaper (we paid about $90 a year for a plan that paid for all but $10 of our eye exams and paid for 6 mos of contacts through husband's old job. What it paid for glasses was almost nothing compared to the specials we were able to find, even when using one of the eyemart places.)

    Make sure you have coverage if you are not at home, that you can seek specialists even if you have to drive an hour or two. Find out how emergencies are handled. Our ins will cover an ambulance ride if it is recommended by the EMTs. A plan we used to have would not cover the ambulance ride if you were not admitted for more than 3 days. Not 3 days or more, more than 3 days. VERY few problems get you admitted for that long and ambulances are very expensive.

    Find out if Urgent Care is covered. Our policy used to only cover the after hours clinic at one location in town. If you went to the ER and it was not life threatening then you paid it all yourself. Even broken bones from car accidents were supposed to wait and go to the orthopedic doctor the next day. A coworker of husband's learned this after her son was in an accident.

    Ask how much premiums and copays will increase the next year. Sometimes you can lock in that rate also, or at least lock in a maximum increase.

    Others will problem have other questions.
  3. JJJ

    JJJ Active Member

    Thanks Susie

    This would only be for husband and I as all of the kids are on Medicaid as part of their adoption subsidy from foster care. They are set until they graduated from high school or turn 21, whichever comes first.

    Supposedly this is the exact same "plan" that the company has, we just wouldn't be part of the group. husband has papers he is bringing home. I will be going over them with a fine tooth comb. The part that worries me is why would the agent give us a way to pay less???? There must be a catch. The catch may be that husband is the boss's son and he wants to keep the account but...?

    We currently don't have dental or vision coverage - the company dropped those a few years ago. I really need dental coverage and this would allow me to get that back. No current problems but a long family history of severe dental problems in our 50s (which are approaching more rapidly than I would like to admit).

    I didn't think about the individual policy not getting finalized in time. Excellent point!!!
  4. susiestar

    susiestar Roll With It

    One of my childhood friend's dad ran a big insurance agency. They are in the business of building relationships, not just trying to get the highest price you will pay. They may offer this because the difference would be very significant between the costs to you. By giving you the indiv policy they may keep the company with them longer because you and your inlaws will be impressed.

    Or they could be lowballing your policy so they can increase it a lot the next year. That also happens. I have to look over our house insurance every year to make sure it stays where I want it. They try to slide things through that decrease what they will pay and increase our costs. My agent is AMAZING, or at least his secretary is, and they always let me know when the change is coming so I can redo it and keep it the way I want it, with replacement values.

    The agent will make a LOT more money over your lifetime if he gives you a good deal, points out where you can save while staying covered, and you stay with him a long time. If he gouges you now and you find out, the company will likely switch away from him. That costs a LOT for the agent as the insurance is a steady revenue stream as long as you have it.
  5. hearts and roses

    hearts and roses Mind Reader

    Our company offers all of our full time employees health insurance. We have several employees who have chosen to only insure themselves and not take a family plan - for various reasons, most often due to the same situation as you. The coverage is exactly the same as if they took a family policy or if they were single. The only difference is that the premiums and deductibles are lower...since the overall expenses the insurance company is likely to are lower. Since the two employees are low risk, such as yourself, they end up with less out of pocket expenses.

    Definitely check with your agent about ANY discrepencies but it sounds just like one of those situations as described above.
  6. KTMom91

    KTMom91 Well-Known Member

    When Hubby and I applied for insurance on our own, we were turned down because we were overweight, had asthma, and were taking medications. We were told we had to lose more than 100 pounds, keep it off for 6 months, and be medication free. Make sure there aren't any little surprises in there.

    Are either you or your Hubby on any medications? Is there prescription coverage at the same level you currently have?
  7. LittleDudesMom

    LittleDudesMom Well-Known Member Staff Member

    If the insurance the agent is offering is with the same company, the transfer could be fairly easy. I would see how extensive the new application process is. If you have any questions, please feel free to pm me or pm and get my number. I was raised by a dad who owned an insurance company and worked for years for a benefits consulting company, as well as being the administrator for our company insurance.