Health insurance.

[Cringer]

Ok, make this quick because I have to get out on the road in a few minutes or so.

I am looking at changing jobs. Without getting into to many specifics about money, the insurance at the new place is going to cost a good deal more, enough that I may have to turn down the job.

So we are scrambling now to find other options. Looking at just getting coverage on our own, possibly, which I have never done. I have always been under my company's plan. So my questions....

1. Who here opts out of their company insurance and gets thier own? What is your experiences doing so, good/bad?

2. What are some good companies/plans that are reasonably priced you may have/had for a family (mine is a family of 3)?

3. Any thing in general I should be on the watch for, good or bad?

4. Ok, just give me your advice if you have any. I would love to have this job, been trying for it for a while now, and would hate to have to walk away from it after I have already been offered the job.

We are already looking at stuff on the internets, but wanted to hear what some guys here have to say about it, if anything.

Thanks.

[Cringer]

Dola-

Need dental too. :)

[Anthony]

could you perhaps give back some vacation days in order for a higher salary (to compensate for the higher benefits)? maybe there's something to negotiate in there, some middle ground.

[Cringer]

Not sure what could be worked out, if anything. I wouldn't give back vacation days though, that is one of the main reasons I want this job.

Basically it comes down to finding my own way, turning the job down, or asking for more money (which would be interesting, since my salary doesn't include regular bonuses and some nice reimbursments which I am sure they would point out to me).


edit: off to the road, I will watch this thread from my phone this week.

[JonInMiddleGA]

I'm afraid that finding your own might be a painfully expensive proposition. Everybody's situation is probably going to be different, but in our case -- family of 3, ages 39/46/8 -- it's currently $900+ per month after a third rate increase in the past two years. And that's just medical, doesn't include dental or prescription coverage.

Like I said, YMMV absolutely, but I just wanted to make sure you were prepared for the possibility of some serious sticker shock if you go that route.

Good luck.

[albionmoonlight]

One big issue is that if you get it on your own and not as part of a group plan, it will be hard to find insurance that does not stick you for pre-existing conditions and the like.

[Flasch186]

I'm afraid that finding your own might be a painfully expensive proposition. Everybody's situation is probably going to be different, but in our case -- family of 3, ages 39/46/8 -- it's currently $900+ per month after a third rate increase in the past two years. And that's just medical, doesn't include dental or prescription coverage.

Like I said, YMMV absolutely, but I just wanted to make sure you were prepared for the possibility of some serious sticker shock if you go that route.

Good luck.

holy shit, do we need universal health care to get out from under the thumbs of so many rackets that are involved in the medical industry.

[Ksyrup]

Group health insurance generally tier-rates, so each group member in the 30-39 age group, for instance, gets the same rate for single/spouse/kids/family coverage. Now, on renewal, they will adjust those rates based on the claims experience of the group, so if one of your co-workers in that age range has a catastrophic illness, everyone pays because they'll jack the premiums up in that age range. But the rate is spread across everyone. And, as albion mentioned, there are typically some state insurance laws which preclude them from excluding certain pre-existing conditions. And the big thing is that they have to take you as part of the group, regardless of your health or the health of a family member.

When you're on your own, you will get rated based on your current health and previous experience, and they can turn you down if they want to. You're typically going to find rates to be higher than what you'd pay through a group health insurance plan at work.

This costs more as well, but you might want to consider, as a temporary solution, paying for COBRA from the old job. I don't know what the difference is in price between the old job and new job (or whether the difference is simply in the co-pay each job is making you pay, with the total premiums being somewhat comparable), but COBRA will cost a little more than the premium was for your existing coverage, but will extend the existing coverage at that higher rate for up to 18 months after you leave the job. But again, that's a temporary solution, and my guess is the difference between the cost to you for insurance at both jobs is based on what they are requiring you to pay of the premium, not the premium itself.

As far as dental coverage, there are some relatively cheap plans out there that cost as little as $30 a month for family coverage and give you 2 cleanings a year for a $25 co-pay and percentages off of any additional work you need done. CompDent and Delta Dental are two I am familiar with.

[Ksyrup]

One other thing to consider, in order to take advatange of group health insurance, is to try to find insurance through an association of which you are (or could become) a member. States are tightening the restrictions on these types of plans, but they still may offer a savings. When I was at the Florida DOI, we had an issue with these because they would set themselves up in a state with lax regulation, issue the policy to the association set up in that state, and give certificates to all of the group members wherever they were located. At the time, they argued that they only needed to comply with the insurance laws of the state in which the policy was issued, which they had hand-picked.

It's not so easy now, but they still exist. There are some associations set up for nothing more than this purpose (with other benefits thrown in to give it some legitimacy), but other associations (like AAA, for example), offer health insurance through their membership plans.

[lynchjm24]

You will probably not have much luck in the individual market unless you are willing to give an HSA a chance.

COBRA probably isn't going to do you much good since you'll be on the hook for the entire premium, you'll no longer get a contribution from your employer. You'd really have to have an unhealthy population combined with an awful employer to be worse off with your new jobs contribution then your old groups COBRA rate.

[lynchjm24]

holy shit, do we need universal health care to get out from under the thumbs of so many rackets that are involved in the medical industry.

Certainly when an industry has a problem, nothing will drive costs down more then getting the government involved.

[wade moore]

Cringer - My general feeling has always been that the odds of getting coverage cheaper as an individual are pretty slim. Do you mind sharing how bad this company's cost is to you?

[Rabeled]

Certainly when an industry has a problem, nothing will drive costs down more then getting the government involved.

Agreed. I salute the Republicans "hands off" approach. Now if we could just get the government out of Medicare and Medicaid!

[Suburban Rhythm]

Not a whole lot to add, other than I was looking at the same a few months ago. At that point with a 2 year old and my wife 8+ months pregnant.

To continue on our current insurer through COBRA was about $850 a month. If we didn't have the kids, we would probably have chanced it, but no way with the kids.

Agree with who ever said above about negotiating at least some of the difference into salary to offset your cost.

And good luck!

[Butter]

Certainly when an industry has a problem, nothing will drive costs down more then getting the government involved.

You don't think the government's involved now? What exactly is Medicare, then?

As for this case, my health care costs are also very expensive (over $300/mo. for insurance, I think I pay 1/3 of the cost or so), but getting it on my own for a family of 4 is over $1000/mo. Even if you think it's bad, you're not going to get good coverage for cheap on your own.

[ISiddiqui]

I think relevant questions to find out is how much are you paying for health coverage now? How much is your employer contributing? How much will it be at your new place (and how much will employer contribute)? You can find out how much COBRA is by asking the first two questions, but COBRA is very expensive. They can charge you 102% of the total premium (2% is for 'administrative fees').

Though the good part with COBRA is if you exhaust your COBRA coverage and then go to an individual policy, you will be able to skirt preexisting condition exclusions. Though you have to fully go through your 18 months of COBRA before you can take advantage of that.

As for the costs involved in health care. IIRC, those countries with 'socialized' medical care have a per capita cost that is less than the US's.

[Flasch186]

Certainly when an industry has a problem, nothing will drive costs down more then getting the government involved.

for another thread...but, youre right the companies that have ridden the gov't. about removing restrictions have not been looking out for their best interests, IE. Enron & California, theyve been looking out for ours.

[Cringer]

Well, I tried the 'asking for more money to cover the difference' angle and it didn't exactly work out too well. :) They said no, which I kind of thought they would.

A couple things here. I asked this question because I really have limited experience with health insurance. I had a couple jobs before Emerson that gave me health insurance, and don't think I ever even had to use it. With Emerson, I started working there right after my 22nd birthday, and with my Loren pregnant.

So, after some thought about it, I kind of reallized I had a sweet deal with Emerson. They are a HUGE company, Fortune 500 I believe. Sales of over $17 billion last year. I think they are probably able to get us one hell of a deal on insurance, and my low premium kind of made the newer company's insurance price look a lot worse then it was perhaps. They admit it's high, but they also had their reasons for it and said they are currently taking steps to correct it as much as possible (which they told me the exact steps they are taking).

We looked around, and in the end it looks like my wife (a realtor) will join the National Assoc. of the Self Employed and we will get insurance through that. Also, getting a plan without maternity coverage cuts the cost down a bunch.

[Galaxy]

As for the costs involved in health care. IIRC, those countries with 'socialized' medical care have a per capita cost that is less than the US's.

A lot more has to be look at then that.

[Buccaneer]

For what it's worth, I just completed the open enrollment for 2007 so I have the numbers in front of me. For many, many years, our company has linked with the local EPO: Medical Network, which was formed by our local hospital system and comprised of most of the medical professionals in our city. Without a basis for comparison, I have always felt we had great coverage. For 2007, we are switching to Sloans Lake but they appear to not be any different in coverage or in providers (except that it has much better coverage for those that had lived outside of the network - like those commuting from Denver or Pueblo). Anyway, here is the cost breakdown for EE+FM (me plus all family members):
Medical - $1290/year (company cost - $9167)
Dental - $919 (company $421)
Vision - $239 (company $63)
plus bunch of life insurance and long-term/short-term disability coverage and such.

I think the main benefit for us is that when we had to use medical services (like two emergency room visits this year), they pay 90%. For dental (which is a need for my wife and my son), they pay 50% for non-routine stuff.

It really doesn't matter how much we pay or will have to pay (this year, the increase in premiums and our COLA raise will end up be the same), the health of my family and myself is most important and I wouldn't want to skimp on this, even it means less take home pay.

[lynchjm24]

You don't think the government's involved now? What exactly is Medicare, then?

As for this case, my health care costs are also very expensive (over $300/mo. for insurance, I think I pay 1/3 of the cost or so), but getting it on my own for a family of 4 is over $1000/mo. Even if you think it's bad, you're not going to get good coverage for cheap on your own.

Clearly, I was talking about further Federal intervention.

So much of the cost of healthcare already is because of the 'government'. With respect to health insurance it's regulated at the state level, instead of the federal most of the time.

Many of the benefits that are mandated are so stupid it's painful. For your employer to have to cover things like Advanced Reproductive Therapy in states like New Jersey is a joke.

The reason why insurance is expensive is because healthcare is expensive. The reason why people are starting to feel that pain now is because employers are passing on more of the cost then ever, hoping that will drive down utilization driving down medical trends (inflation).

[lynchjm24]

So, after some thought about it, I kind of reallized I had a sweet deal with Emerson. They are a HUGE company, Fortune 500 I believe.


Quick lesson.

There are two different ways that a company can provide insurance for their employees. It can be Fully-Insured (Conventional) or Self-Insured. Within Fully Insured there are a number of different funding arrangements, but the most popular is 'Prospective'.

A prospective group is underwritten and they have 'rates'. These rates stay the same for 12 months regardless of how the group runs. They can have every employee never go to the doctor or they can have every member spend a week in the hospital - the group just pays the rate by tier for each enrolled employee.

Self insured groups are exactly that. The company pays a fee to an insurance company to adminster the claims and gain access to a network. Then as claims are processed, the group pays the claims through a bank wire. Protection is available to these groups in two ways (stop-loss). Groups can have an Individual Stop Loss limit, this limit depends on the group size and their appetite for risk. A 500 life group (lives=employees enrolled) might have an Individual limit of 100,000. The group would be on the hook for the first 100k on every member and then stop loss insurance covers the dollars past 100k. Also, there is a aggregate claim limit that the group can get protection on. Typically this is 25% above what the projected claims are for the group over a 12 month period (this can vary from between 10%-35%.

So this is what can happen and what drives the individual costs by company.

At a small company, demographics are important (including the industry), there is class/manual rating that comes into account to spread the risks between groups. However if you work with sick people you are going to pay the price. If you work at a company that has a family with a few hemophiliacs who are going to be 1MM claimants year after year, your contribution is going to partially fund those claims, because the insurer knows that these claims are going to repeat.

At larger companies, there is more people to spread the risk over. Larger companies that self fund are also less profitable to insurers because they don't carry as much risk and are easier to price.

So given two companies that are willing to fund at the same level (say they cover 70% and pass on 30% to the employees), you are almost always going to be better off at the larger company that self-funds their claims. A company with between 125-300 employees probably has the most volitale costs as they aren't protected by as much pricing legislation and a few large claimants can drive up costs, with few to spread it over.

As for the costs involved in health care. IIRC, those countries with 'socialized' medical care have a per capita cost that is less than the US's.

This is because of a lot of complicated reasons. Over 1/4 of Medicare spending goes towards people in the last year of their lives. Many of the socialized medicine countries don't spend hundreds of thousands of dollars to extend life at a poor quality for a short period of time.

These countries also don't have a legal system that has provided huge awards for victims of malpractice.

[Buccaneer]

That's interesting, Jim, I never knew how it worked in larger companies.

[Cringer]

Quick lesson.

There are two different ways that a company can provide insurance for their employees. It can be Fully-Insured (Conventional) or Self-Insured. Within Fully Insured there are a number of different funding arrangements, but the most popular is 'Prospective'.

A prospective group is underwritten and they have 'rates'. These rates stay the same for 12 months regardless of how the group runs. They can have every employee never go to the doctor or they can have every member spend a week in the hospital - the group just pays the rate by tier for each enrolled employee.

Self insured groups are exactly that. The company pays a fee to an insurance company to adminster the claims and gain access to a network. Then as claims are processed, the group pays the claims through a bank wire. Protection is available to these groups in two ways (stop-loss). Groups can have an Individual Stop Loss limit, this limit depends on the group size and their appetite for risk. A 500 life group (lives=employees enrolled) might have an Individual limit of 100,000. The group would be on the hook for the first 100k on every member and then stop loss insurance covers the dollars past 100k. Also, there is a aggregate claim limit that the group can get protection on. Typically this is 25% above what the projected claims are for the group over a 12 month period (this can vary from between 10%-35%.

So this is what can happen and what drives the individual costs by company.

At a small company, demographics are important (including the industry), there is class/manual rating that comes into account to spread the risks between groups. However if you work with sick people you are going to pay the price. If you work at a company that has a family with a few hemophiliacs who are going to be 1MM claimants year after year, your contribution is going to partially fund those claims, because the insurer knows that these claims are going to repeat.

At larger companies, there is more people to spread the risk over. Larger companies that self fund are also less profitable to insurers because they don't carry as much risk and are easier to price.

So given two companies that are willing to fund at the same level (say they cover 70% and pass on 30% to the employees), you are almost always going to be better off at the larger company that self-funds their claims. A company with between 125-300 employees probably has the most volitale costs as they aren't protected by as much pricing legislation and a few large claimants can drive up costs, with few to spread it over.



Interesting, and thanks for the lesson. Emerson actually was self-insured when I signed on with them I believe. They switched over to fully insured several years ago (when we went to Blue Cross/Blue Shield Alabama). I don't remeber how much our premiums changed, but it wasn't a ton. Somewhere around $10.

And to compare, Emerson (job I am leaving) probably has 10,000+ employees nationwide. That is a complete guess, but they have a ton of plants, warehouses, etc. all over. The new company (though I have no idea how many they have) can't have much more then 100 employess, if that much.

[Galaxy]

As for the costs involved in health care. IIRC, those countries with 'socialized' medical care have a per capita cost that is less than the US's.

This is because of a lot of complicated reasons. Over 1/4 of Medicare spending goes towards people in the last year of their lives. Many of the socialized medicine countries don't spend hundreds of thousands of dollars to extend life at a poor quality for a short period of time.

These countries also don't have a legal system that has provided huge awards for victims of malpractice.

I've heard that one reason is that doctors order more tests, ect. than required in security of being sued.

[Crapshoot]

Fyi, litigation is often cited as a primary cause, but the last study I read on the subject suggested it was reponsible for a 1-2% rise in costs - hardly the entire cause for price rises. I'll try and dig out the study in question.

[MacroGuru]

well....is this where I can chime in....

Let me tell you, the thought is there when open enrollment hits that I may hunt for my own in Utah, however I have never had insurance as awesome as this. They basically cover everything 100%. They just make you jump through the hoops to get that coverage.

My wife needed an MRI, so she had to go to our Primary Care, he made the request, the company said to attend 10 sessions of PT and then based upon what the PT said, they would pay for the MRI, the PT scratched his head and said, well I need the MRI to help see what work you need. So he had her do the bare minimum she could, then wrote his diagnosis, MRI was paid for.

I will say, I do know it's expensive but some of the bonuses and such will help out, trust me, but then again....you may luck out some more.....

[Flasch186]

lemme tell you about a little company called United Health care (UHC). Here is how it works. You sign up to pay for a PPO (which everyone is under the impression is better than an HMO - thats how they market it anyways) however UHC makes doctors sign up for a company called ACN Group to be able to be a part of the UHC network. When you go to the doctor, the first time, the Dr. is to make you fill out a form with the anatomy on it and scales of 1-10. From there you describe your pain (1-10), where it hurts, how long you've had the pain, etc. The doctor is then to do minimal diagnosis and work on you that trip while they fax ACN Group your form. Then the Dr. is to call you or inform you on your next visit, just what he can do to you, what tests he can run, how long he can see you, etc. So basically, instead of having the patients pay for an HMO they sell you a "PPO" but then force the Dr. to behave as if it is an HMO anyways.

I called UHC to inquire about this when I first learned that not only is my Dr. going to be controlled by ACN group going forward but that because she didnt follow UHC's directions with ACN group she wouldnt be getting paid for her work in the past. (She is being nice enough to just write it off and not try to come after me for it.) Upon this phone call I asked the Customer Service Rep. to explain ACN group and she explained it as another contractor that they hire to administer things. I asked if UHC owned them and she hmmmed and hawed before saying, "well not really. Theyre a subcontractor." When I stated that I dont recall ever signing anything giving permission to have my health insurance outsourced to another company, she said, "Well we own them." I re-asked, "So you own them?" and she backtracked again, "Well we dont own them, own them...but they work for us and for someone to use UHC the Dr. has to sign up for ACN." We went around in circles before she realized what I getting at and clammed up pretty good. So basically ACN group is an HMO but theyre backdooring it on the paying subscribers of UHC by going to the doctors. The part that pisses me off the most is that I was never informed of this, I only learned of this when my Dr. showed me the letter I had to make a copy of.

If I had the cojones I would fight my HR dept. about this but I know it'll be a fruitless battle but in my opinion, the way it is setup is a scam and in talking to almost all the people I dare talk to about this, within the company and management, the consensus 100% of the time is that our health insurance is horrible in our company.


EDIT to add: this is for Chirpractic stuff for my messed up back and neck (I actually tore a neck muscle once, the stringy one that connects to the bottom of your skull). I dont know what specific outsource they use for other things.

[lynchjm24]

Interesting, and thanks for the lesson. Emerson actually was self-insured when I signed on with them I believe. They switched over to fully insured several years ago (when we went to Blue Cross/Blue Shield Alabama). I don't remeber how much our premiums changed, but it wasn't a ton. Somewhere around $10.


My guess would be that the increase in the expenses paid to the insurance company (in this case BC/BS of AL) was equal to the amount that was saved in the way of better discounts with providers.

Anyone out there buying individual insurance needs to keep in mind that the discounts are also important. You might end up with a lower premium from one carrier over another, but if when you get to the doctor the discounts are worse you didn't really 'save' anything at all - you can end up paying more if you have high deductible and coinsurance limits.

The differences in discounts can be stark. Just going across a state line in the same area can be huge. Being with a company like Oxford or Aetna in NY/NJ would provide great discounts. Move that person to New Haven, Connecticut and their discounts will not compete with Anthem or Connecticare. It's very difficult even for large companies to compare discounts, as they are mostly self-reported and it's not as though you can provide a test environment for a group. Hell it's difficult for me as an underwriting manager to access how my company compares to other companies when considering their claim experience.

[lynchjm24]

If I had the cojones I would fight my HR dept. about this but I know it'll be a fruitless battle but in my opinion, the way it is setup is a scam and in talking to almost all the people I dare talk to about this, within the company and management, the consensus 100% of the time is that our health insurance is horrible in our company.


United does own the ACH Group and they only handle chiropractic claims. My guess is that they exist to try and ensure best practices and save money at the same time. Not to defend what they are doing here, but so much money is wasted by medical professionals because there are not standards of practice and the there are no standards of care, which is really what United's now disgraced CEO was always trying to accomplish.

99 times out of a hundred when a member is blaming the insurance company for what is covered, it's really their employer's fault. They choose what is and what isn't covered, the insurer just administers what is purchased. Anytime HR can pass the blame along, they will though.

[ISiddiqui]

Fyi, litigation is often cited as a primary cause, but the last study I read on the subject suggested it was reponsible for a 1-2% rise in costs - hardly the entire cause for price rises. I'll try and dig out the study in question.

I have seen studies that suggest this as well... and malpractice claims, which some states have turned to, have no stopped the rising cost of insurance premiums. Litigation has turned into a red herring, IMO. There are other factors at work driving up the cost of medical care.


lemme tell you about a little company called United Health care (UHC).

They are horrid. The interesting thing is that their customer service reps probably are trained to send all questions to the Department of Labor, and when those questions involve what is covered by the plan or about premiums, the DoL ain't going to be able to answer the question. Results in a lot of angry participants, who are told to call UH again and refuse to be transfered.