engineerdoe
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Post by engineerdoe on Nov 5, 2019 20:10:37 GMT -5
Based on what you have listed here, you wouldn't meet your individual deductible nor the family one. Physicals and mammograms would still be no cost as they are preventative. Not sure about the EKG for ODS and the colonoscopy would depend on age and I think you may be too young to meet the age requirement but obviously you somehow meet the risk requirement to get one. My vote is always to go HSA route especially if your employer is going to contribute to the account. So yes, you would receive a bill for $150 for a Urgent Care visit but not for the physicals, mammograms and labs. Not sure about the eye doctor either. I guess it depends if the visit is for medical or vision. But those costs are all full price before the network discount, I'm assuming I would still get the discount moving to the HSA still under BCBS? Like the urgent care costs are $123 after discount, Carrot's specialist is $105, the colonoscopy was only $2300 instead of the list $5518 (don't need another one of those for 10 years)
As hoops said, you get the same discounted price that the insurance company gets. I still vote for HSA but you do need to plan to build up the account so you have at least the deductible saved. Of the plans you were offered, in the worst case scenario of having all the family members use up the max OOP the HSA 1500 is technically the cheaper plan and you get $1000 from your employer. The only thing about that one is I am not sure a $1500 individual deductible counts as a "high deductible" plan to get the tax benefits. I know it used to but I think the number has been rising. Oh, and on the HSA plans what you pay for your medication is applied to your deductible.
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Deleted
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Post by Deleted on Nov 5, 2019 21:44:24 GMT -5
DS just came home today and said he wants to get his wisdom teeth removed and I'm supposed to call the dentist to set something up. They're impacted so it would be oral surgery.
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NastyWoman
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Post by NastyWoman on Nov 5, 2019 21:48:54 GMT -5
What happens if DS1 attends an out of state college? Will he still be (double) covered? Will he even remain covered by his dad after he turns 18? While my kids were in college I always ended up with the most expensive option since that was the only one offered that provided out of state coverage He can stay on our plans until he's 26. I guess I never asked ex and just assumed he'd keep him on because he has to have family coverage for all his other kids and it doesn't cost more. The network coverage is the same on all three, we're not limited to in-state. All the university healthcare centers he's interested in take it as well as the surrounding communities...maybe not everybody, but there are providers popping up on the search for all those towns. That wasn't quite what I meant. Of the plans I had available only one covered out of state care as in network. The others had ridiculous co-pays for out of state healthcare
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bean29
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Post by bean29 on Nov 6, 2019 2:15:40 GMT -5
The main difference between a PPO and HSA is the cash flow. Calculating premiums for the year and meeting the OOP totals all those plans technically "cost" the same. Just understand that a doctor's appointment (not preventative care) will now cost you about $150 to $200 instead of the nice $20 or $35 co-pay. If your employer deposits that $1000 at the beginning that isn't as big a deal as you will have the cash in the HSA already. I would confirm with HR or the insurance broker, that the HSA plans will still allow you to use Express scripts and just know that the negotiated price can still go up. Can you show the math you're using to show they all cost "the same" if you hit the premiums plus max OOP? For PPO it would be $12,400, HSA 1500 it would be $10,244, HSA 5000 would be $13,820...I'm not sure I'd call $3,500 nothing (difference between HSA 5000 & HSA 1500). That's also making a pretty large assumption that you're going to hit Max Family OOP amount for the year (not just one person in the case of the PPO & HSA 5000, but multiple people). Our insurance the HSA is cheaper b/c OOP Max is significantly less. (In Prior years) My company has paid the premium 100%, so the comparisons are different.
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giramomma
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Post by giramomma on Nov 6, 2019 12:16:28 GMT -5
DS just came home today and said he wants to get his wisdom teeth removed and I'm supposed to call the dentist to set something up. They're impacted so it would be oral surgery. How is dental covered? Oral surgery would fall under dental. My plain dental doesn't cover it, but supplemental dental does. Otherwise, is there a particular rush to getting that done? I didn't have my wisdom teeth out until I was 19/20. Otherwise, just know your risks. We switched over to an HSA because we were at a sweet spot with the kids..no one was driving..kids aren't sickly, we weren't old enough to start falling apart, etc etc etc. I got pregnant 3 months later... I'm back on a PPO now.
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Deleted
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Post by Deleted on Nov 6, 2019 12:30:58 GMT -5
giramomma - I just hung up with the dentist. DS wants it done over Christmas break, so they scheduled it for December 26th. It's going to be done by the oral surgeon and will be covered by medical. This is my double covered kid (medical and dental) and his dad usually meets the family deductible due to his diabetes, so it should be about the best time to do it. I don't know if it all just gets shoved to medical, but our Delta Dental card says it covers 50% of oral surgery up to an annual max of $1500.
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justme
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Post by justme on Nov 6, 2019 12:36:24 GMT -5
I'd definitely double check that. I had to have my wisdom teeth out for a second time and it was 100% under my dental coverage and it was done by an oral surgeon.
The first go-round was partially covered by medical as it prompted by an oral cyst they needed to remove - but my parents had to pay the additional cost to remove the 3 wisdom teeth as that wasn't covered under medical. (This was pre-ACA but my parent's plan didn't change after ACA)
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Deleted
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Post by Deleted on Nov 6, 2019 13:09:16 GMT -5
I'd definitely double check that. Well, I tried reading through the medical benefits book and it was confusing as hell so I gave up. The surgeons office told me to bring his medical insurance card. I asked about dental and they said the dentist would send a copy of that with the xrays.
As usual, I'll kick back and say "I wonder what this is going to cost?"
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justme
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Post by justme on Nov 6, 2019 14:18:27 GMT -5
I'd definitely double check that. Well, I tried reading through the medical benefits book and it was confusing as hell so I gave up. The surgeons office told me to bring his medical insurance card. I asked about dental and they said the dentist would send a copy of that with the xrays.
As usual, I'll kick back and say "I wonder what this is going to cost?"
Ah, that's different than my doctor was it seems. Mine asked for all my medical/dental insurance info and the consultation visit ended in the finance or whatever office going over what my insurance cost and what I'd have to pay.
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Deleted
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Post by Deleted on Nov 6, 2019 14:55:42 GMT -5
Well, I tried reading through the medical benefits book and it was confusing as hell so I gave up. The surgeons office told me to bring his medical insurance card. I asked about dental and they said the dentist would send a copy of that with the xrays.
As usual, I'll kick back and say "I wonder what this is going to cost?"
Ah, that's different than my doctor was it seems. Mine asked for all my medical/dental insurance info and the consultation visit ended in the finance or whatever office going over what my insurance cost and what I'd have to pay. The only time I ever remember doing anything like that ever with a doctor or dentist office was at my first prenatal visits with both my kids and I think that was because I was signing a contract about it all being under one billing (package deal for all the prenatal visits).
I might stop in and talk to them on the way home today since I drive right by that clinic on my way home.
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knot12gossip
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Post by knot12gossip on Nov 7, 2019 10:24:18 GMT -5
Subscribed
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Deleted
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Post by Deleted on Nov 7, 2019 10:51:27 GMT -5
So, we had our benefits meeting today and our GM was saying how our company is self insured and BCBS is just an administrator for the plan. Is that normal? I always thought the insurance company was paying out the claims.
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wvugurl26
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Post by wvugurl26 on Nov 7, 2019 11:06:43 GMT -5
So, we had our benefits meeting today and our GM was saying how our company is self insured and BCBS is just an administrator for the plan. Is that normal? I always thought the insurance company was paying out the claims. It's common. My aunt's old company was self insured. The insurance company helps them design the plan and administers it, but the company is cutting a check to the insurer for what it pays out.
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Post by The Walk of the Penguin Mich on Nov 7, 2019 11:22:57 GMT -5
So, we had our benefits meeting today and our GM was saying how our company is self insured and BCBS is just an administrator for the plan. Is that normal? I always thought the insurance company was paying out the claims. It was the same way my insurance worked when I worked in KY. No, it is not the same everywhere. The advantage is that if you have a healthy work staff, your premium cost stays low. If you have an expensive year, it can jump higher.
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justme
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Post by justme on Nov 7, 2019 11:32:23 GMT -5
So, we had our benefits meeting today and our GM was saying how our company is self insured and BCBS is just an administrator for the plan. Is that normal? I always thought the insurance company was paying out the claims. Most governments have self pay insurance. As well as most large companies. And it's not just health insurance. My company self-pays for our truck fleet insurance too. It makes accidents with company vehicles more fraught because it's not sure insurance companies not wanting to pay out - but the exec team too.
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Deleted
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Post by Deleted on Nov 8, 2019 9:50:50 GMT -5
He can stay on our plans until he's 26. I guess I never asked ex and just assumed he'd keep him on because he has to have family coverage for all his other kids and it doesn't cost more. The network coverage is the same on all three, we're not limited to in-state. All the university healthcare centers he's interested in take it as well as the surrounding communities...maybe not everybody, but there are providers popping up on the search for all those towns. That wasn't quite what I meant. Of the plans I had available only one covered out of state care as in network. The others had ridiculous co-pays for out of state healthcare We aren't limited to in-state. Our company has sites all over the country and we share the same insurance plan.
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Post by The Walk of the Penguin Mich on Nov 8, 2019 13:56:33 GMT -5
That wasn't quite what I meant. Of the plans I had available only one covered out of state care as in network. The others had ridiculous co-pays for out of state healthcare We aren't limited to in-state. Our company has sites all over the country and we share the same insurance plan. Yes. If your company is more national or international, it seems that the healthcare options are much more flexible if you are outside of your home location. TD’s company is international, so his health insurance covers us overseas. It has eliminated one of our needs for travel. When he retires and go on Medicare too, we are going to have to revisit this....but for now we are good.
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Deleted
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Post by Deleted on Nov 19, 2019 14:13:25 GMT -5
I have one more day and have changed me elections at least 4 times in the past week. Low medical expenses - HSA 5000 best deal. Super high medical - HSA and PPO pretty close to a wash (Premiums + Max OOP for one person = $8420 PPO vs $8110 HSA) It's that dang middle ground that I'm not sure on, but I know I can spend $4100 out of pocket and still have it be a wash to the PPO.
I think I'm going with the HSA 5000. Final answer.
Maybe.
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bookkeeper
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Post by bookkeeper on Nov 19, 2019 14:48:56 GMT -5
DS just came home today and said he wants to get his wisdom teeth removed and I'm supposed to call the dentist to set something up. They're impacted so it would be oral surgery. How is dental covered? Oral surgery would fall under dental. My plain dental doesn't cover it, but supplemental dental does. Otherwise, is there a particular rush to getting that done? I didn't have my wisdom teeth out until I was 19/20. Otherwise, just know your risks. We switched over to an HSA because we were at a sweet spot with the kids..no one was driving..kids aren't sickly, we weren't old enough to start falling apart, etc etc etc. I got pregnant 3 months later... I'm back on a PPO now.
The roots on those wisdom teeth can just keep growing in some people. Our older son had his out at age 16. Was sore for a weekend, but bounced back. Our younger son had his done at age 20. The surgeon was not able to extract the tips of the roots because doing so would have cut a nerve that controlled quite a bit of sensation in the face. As it was explained to me, earlier is better.
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