Company medical vs. individual policies
Does anyone have an individual policy instead of using whatever group coverage is offered through their company? Or maybe you don't have group coverage? We're obviously planning for insurance once the babies get here and here is a comparison.
We pay more out of pocket for premiums,
deductibles, and coinsurance for less coverage through his company,
than we would for an individual family policy direct through BCBS of
AL. We currently have plan #1, but only pay half of the premium you
see here (these are all based on covering a family, not just the two of
us).
Company premium #1 (an HMO/POS) - $917 a month
Company premium #2 (this doesn't include HSA contributions) - $582 a month
BCBS of AL premium (an HMO) - $295 a month
Company deductible for family #1 - $450 (OOP max $4500)
Company deductible for family #2 - $3300 (OOP max $6000)
BCBS of AL premium for family - $2275 (not sure on OOP max, but it was 5-6 I think)
Company
copay #1 - $35 / $50 (specialist) / $250 ER/hospital/surgery + 10%
coinsurance for anything inpatient or surgery, everything else covered
100% after copay
Company copay #2 - $0 - everything is OOP up to the
$3300 (pay with HSA) and then the plan pays at 80% except for well baby
visits
BCBS of AL copay - $40, everything at 100% at $40, most diagnostic stuff doesn't even have a copay
Re: Company medical vs. individual policies
Insurance varies widely by state in terms of cost and what they must cover. Even though you are on the adoption path if there is any way you could get PG be very careful about finding out how it works in your state. In my state (VA) a maternity rider is over $100 extra per month on an individual plan whereas with company plans maternity is required and built into base fee for everyone (and some companies also elect to add IF assistance). So, for a woman with any chance of getting PG (forgive me, if this is an insensitive assertion--I don't know your history), a company policy is almost always better and you are in deep doodoo if you don't have one and do get PG.
In my state individual plans also have a waiting period for all other pre-existing conditions whereas company plans do not. So if you have asthma, depression, carpal tunnel, heart issue, anything that is an already identified problem proceed with caution!
Now, it might be totally different in your state. But for me, a company plan is well worth it.
More Green For Less Green
I know *** and squat andI stared at that information blankly (the Mr. deals w/ that crap. I cook, he does insurance--so a worthy trade in my book :-P)...
But a tiny tidbit from the last time I was laid off, if you currently have group coverage and no longer wish to have group coverage, 'group conversion plans' are often much more affordabe and better coverage than normal 'individual' policies.
And youi may have already looked into it, but, when I was unemployed, COBRA was absurdly expensive. So our ins. guy told us to call HR to find out who at BCBS we had to talk to about a group conversion plan--to convert from a group to individual. After HR told me no such person existed, repeately, they gave me a # and BCBS sent me info on all their group-conversion plans--it was 1/3 of the cost of COBRA w/ MUCH better coverage than we had seen on any of the rest of the individual plans (which I know because Both the Mr and I ended up in the ER while we had it...) And there is no lapse in coverage and no pre-existing condition BS.
Just a thought, might not be helpful, but figured I'd throw it out there :-)
We were denied an individual insurance plan solely because we are in the process of adopting! Our homestudy has not even begun yet, but we our application was approved by the agency almost a year ago and we have already paid some deposits. We therefore honestly answered the question on the insurance application which asked whether we are considering adopting a child or in the process of adopting a child. As a result, we were denied and this was the sole reason for the denial.
The reason we were provided is because they are unable to do any underwriting on our as-yet-unknown child and traditionally, adopted children have more health problems. It did not matter that we were only attempting to insure ourselves. I was shocked! This is perfectly legal in our state. Legally, if they insurance us, they also have to insure any child we have, either biologically or through adoptioon, so they just refused to insure us. Group coverage is different and they usually you cannot be denied for this reason with group coverage. The aadditional problem is, now, when asked if we have ever been denied health insurance for any reason, we have to answer "yes."
We are now insured through my company's group health insurance, I work for a smaller business and the premium for two fairly healthy adults (for which we have to pay 100%) is $1200/month with a high deductible and no coverage for fertility. My husband is self-employed and we were attempting to get insurance with a lower premium.
Based on our experience, I would stick with group coverage if it's available.
Prudence, I would be protesting that all the way to my State Insurance Commissioner -- especially since now you have to always answer that you've been declined coverage.
Luckily, they won't decline us for that reason -- they did say that insure potential adoptive parents all the time, so that's good. They did advise waiting until the first baby gets here, so we can all be added at one time, but if I were you I would definitely protest to my State Insurance Commissioner!
We're still going back and forth on the pros and cons, but luckily our state has very strong individual insurance consumer laws, so I'm feeling more and more comfortable moving in that direction.
MrsB - I have been working with our adoption agency and we have contacted local legislators about this issue. The insurance company lobby has been pretty effective in our state. It's been a real eye-opener, that's for sure.
BTW, I used to live in Mobile (over 12 years ago). It sounds like I should move back.
Oh, and I apologize for all the typing errors in my previous post. I should have proofread it!
We're not native Mobilians but we love it here! Low cost of living and friendly folks.
GL with your insurance snafu -- keep me up to date! I work in insurance, just not medical, so I know it's the squeaky wheel that gets the attention. Keep at it!