Deleted
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Post by Deleted on Feb 23, 2016 8:03:12 GMT -5
If you guys say so. However, I suggest that you read the fine print under Major Medical to make sure. Mine, by the way, is considered a "Cadillac plan" under ACA and will soon be subject to taxation unless something changes. The word "deductible" is used in the following descriptions:
Here's what mine says: $300 person or / $900 family per calendar year for Major Medical Services. Does not apply to preventive services, physician, inpatient, drugs, non-covered services, most copays, balance-billed charges and pre-certification penalties.
Hospitalization: $200 per hospital admission.
Out-of-pocket limit: $400 per person per calendar year for Major Medical Services. Overall calendar year out-of-pocket is $6,600 per person/$13,200 per family.
I can easily picture someone saying that our plan has "no deductible" because they never use Major Medical Services. I haven't used it in decades. But it is in there
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resolution
Junior Associate
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Post by resolution on Feb 23, 2016 8:10:25 GMT -5
Mine has a handy dandy little chart
Plan Year Deductible - None Out of Pocket Max - None Lifetime Max - None
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wvugurl26
Distinguished Associate
Joined: Dec 19, 2010 15:25:30 GMT -5
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Post by wvugurl26 on Feb 23, 2016 8:10:31 GMT -5
I was hospitalized for three and a half days and had surgery last year. I paid $48. Pretty sure that is major medical.
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resolution
Junior Associate
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Post by resolution on Feb 23, 2016 8:15:52 GMT -5
I have never been hospitalized, but I had to see a neurologist last year, get an MRI and nerve mapping tests, which ran the insurance thousands of dollars and cost me a $40 copay for the neurologist appointment.
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Cookies Galore
Senior Associate
I don't need no instructions to know how to rock
Joined: Dec 19, 2010 18:08:13 GMT -5
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Post by Cookies Galore on Feb 23, 2016 8:33:03 GMT -5
I'm looking at our plan now and imaging, inpatient/outpatient surgery, maternity (first ob visit is $15), chemo, radiaton, dialysis, and other things are 100% covered. A coworker did go through chemo and radiation so I know she was covered for her treatments. Appointments with my PT and sports med ortho are $15. We do have a $1,000 max out of pocket, which includes out of network deductibles, copays, coinsurance). I haven't had anything more major than blood work a few times, an US, and x-rays since I've been on this plan. Those things didn't cost me.
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Deleted
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Post by Deleted on Feb 23, 2016 8:49:44 GMT -5
Mine is $216/month for single. Pink I thought the point of single plus one was to be cheaper than family coverage. I know our premiums are different than yours though. I'll have to check tomorrow. I now have a $250 deductible and $2500 max out of pocket. Last year was $214/month, no deductible and $1900 max out of pocket. Open access HMO, no referrals necessary, $25 PCP, $35 specialists, $100 ER copay waived if admitted, $0 generic drugs, $35 tier one generics, $65 non preferred generics and $150 for self injectibles including epi pens. The lovely self injectibles tier came into existence after they hired CVS Caremark as their PBM. Nothing would please me more than to nail CVS to the wall for their multiple shady business practices. I've hit the out of pocket maximum by November the last three years. If I can stay out of physical therapy and away from operating rooms this year, I might not hit it. Our premiums are less, thanks to the unions. Did you know you can use one of the union plans? A lot of employees think they have to be covered by the unions to use their health insurance, but they don't. Just a FYI. Most of the companies' self+1 options were a few dollars less, the plan I chose just happened to be the opposite. Because of OPM guidelines, the formulas they use, and the demographics of the people on the plan. ETA: it's also the plan that reduced the premiums significantly this year. Family coverage was closer to $500/month last year IIRC. Specialist copays and the deductible went down also.
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aprilleigh
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Joined: Dec 20, 2010 15:22:50 GMT -5
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Post by aprilleigh on Feb 23, 2016 15:47:08 GMT -5
My company pays 100% of premiums for employee + family. It's crazy. We used to have the policy of 100% coverage for employee, 0% for family, but in reality we'd pay the family premium instead of raises. But my agent said what we typically do has to align with the policy, so now, officially, we pay 100% of the premium for everyone.
We have an HMO plan (Kaiser) that is not subject to certain ACA requirements. Premiums are $403 for employee, $1211 for family.
We have a $500 deductible (subject to deductible: ER, hospitalization, surgery) + 20% co-insurance up to an out-of-pocket max of $2000 annually (per person). Most routine visits are a $20 copay, specialists are $25, Urgent Care is $40.
I tell my husband I stay in this job for the cushy insurance, but he always points out that we NEVER use it. Except for my BC, $0 out of pocket, 3 months mailed to me at a time ... I also kinda wish my employees really understood how much it costs. I also wish my boss would water down the coverage a little, to decrease the premiums. We pay over $15,000 per month for 20 employees.
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kittensaver
Junior Associate
We cannot do great things. We can only do small things with great love. - Mother Teresa
Joined: Nov 22, 2011 16:16:36 GMT -5
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Post by kittensaver on Feb 23, 2016 16:43:02 GMT -5
In my world - a deductible is an annual amount that you *must* spend first before any insurance benefits will kick in. With some plans, you are then free of any other costs until the year is over; in other plans, you have met the deductible but will still have a co-pay (a share of cost).
It all depends on the carrier, the insurance rules of your State and the way the plan is written.
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