health insurance

[fun8stuff]

could anyone more familiar with health insurance tell me if this is good or not? how does it compare to what you havE?

Low Option High Option
Plan Name Blue Cross Blue Shield Blue Cross Blue Shield
Community Blue PPO Community Blue PPO
Plan 4 Plan 2
Deductible
1 Person - In Network/Out of Network $500/$1000 $100/$250
Family - In Network/Out of Network $1000/$2000 $200/$500
Copayment Percentage
In Network/Out of Network 20%/40% 10%/30%
Copayment Maximum
1 Person - In Network/Out of Network $1500/$3000 $500/$1500
Family - In Network/Out of Network $3000/$6000 $1000/$3000
Physician Office Visit Copayment $10 $10
Emergency Room Copayment $50 $50
Prescription Drug Copayment $15 Generic $15 Generic
$30 Formulary $30 Formulary
$60 Brand Name $60 Brand Name


Premium
Low Option High Option
Annual - Effective 8/1/05 to 7/31/06
1 Person $2,667.72 $2,955.60
2 Person $5,936.40 $6,584.16
Family $7,049.28 $7,826.64
Family Continuation $1,333.44 $1,478.04

Semi Annual - Effective 8/1/05 to 1/31/06
1 Person $1,333.86 $1,477.80
2 Person $2,968.20 $3,292.08
Family $3,524.64 $3,913.32
Family Continuation $666.72 $739.02

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[Soleil9]

Yep, it's REALLY expensive. I'm still working on comparing the pluses and minuses with my current insurance (through my husband). The bad thing is that we won't get an increased financial aid budget to cover any insurance except theirs. And with theirs, they'll cover it in the financial aid so I guess it won't subtract any from our pocket money....

Also, it seems that Community Blue only has limited participating members outside of the Detroit Metro area. So what happens when I go home (to Grand Rapids) on the weekends, or during our 2 month summer break? I always seem to get sick when I am away from my family doctor.

Another minus: the expensive medication plan! $15 generic $30 preferred and !@$#@!@!! $60 other????????? What? What if my perscription is on the $60 list? Geez. I'm still looking for a list of what drugs are included in each bracket. Let me know if you find something......

But I am still looking into this plan.... Maybe there are some plusses I haven't seen yet.....

 

[katrinadams9]

All I can say is that god I'm covered under my fiance.... soon to be husband (in 3 days). We decided to move up our wedding date so I could opt out of this ridiculously expensive mandatory insurance plan.

 

[dancinjenn]

All I can say is that god I'm covered under my fiance.... soon to be husband (in 3 days). We decided to move up our wedding date so I could opt out of this ridiculously expensive mandatory insurance plan.

Conrats Katrina. I too am lucky to be covered under the hubby. This plan is more expensive than the one from last year, but the coverage is WAY better. Figures that WSU would come up with one of the most expensive plans known to man...because we all have this extra money tucked under our mattresses!

 

[Soleil9]

All I can say is that god I'm covered under my fiance.... soon to be husband (in 3 days). We decided to move up our wedding date so I could opt out of this ridiculously expensive mandatory insurance plan.

You're moving up the wedding date for heath insurance?!! WSU should be ashamed of themselves. But congrats anyway!!!!!

 

[katrinadams9]

You're moving up the wedding date for heath insurance?!! WSU should be ashamed of themselves. But congrats anyway!!!!!

We're still having our original wedding ceremony as planned... just told immediate family and our wedding party what's up. The rest of the guests will just think december 17th is our wedding date.

 

[fun8stuff]

Yep, it's REALLY expensive. I'm still working on comparing the pluses and minuses with my current insurance (through my husband). The bad thing is that we won't get an increased financial aid budget to cover any insurance except theirs. And with theirs, they'll cover it in the financial aid so I guess it won't subtract any from our pocket money....

Also, it seems that Community Blue only has limited participating members outside of the Detroit Metro area. So what happens when I go home (to Grand Rapids) on the weekends, or during our 2 month summer break? I always seem to get sick when I am away from my family doctor.

Another minus: the expensive medication plan! $15 generic $30 preferred and !@$#@!@!! $60 other????????? What? What if my perscription is on the $60 list? Geez. I'm still looking for a list of what drugs are included in each bracket. Let me know if you find something......

But I am still looking into this plan.... Maybe there are some plusses I haven't seen yet.....

good points. if you happen to get yoar hands on a list of covered do you think that you could post a list here ?

so does the deductable mean that you have to pay that Much before the copayments take effect ?

I think I might be Screwed. I was covered under my ster dad, but kheis divorcing my mom, So I need to get Something, and there is very little tiMe left!

By The way, congrats Kristina! I plan oN getting married Soon, but my fiance/gf has 2 years .=. of undergrad left!

 

[rpkall]

I wish I could just promise not to get sick and/or die, and they would take my word for it. I can't wait until MS2, when my wife will have a full-time job with bennies. I bet it's so damn expensive because med students go to the doc every 5 seconds because they think they have every disease they read about.

This week, I'm sure I have a fatal case of chondromalacia. Either that, or I was fat for 20 years and my knees hurt now. You decide!

 

[chicadehuskers]

so does the deductable mean that you have to pay that Much before the copayments take effect ?

yes. That is what that means. You're responsible for everything until you've paid off the deductible. Then your insurance company covers 80% of all costs beyond that amount, and you cover 20% (if it's an in-network provider).

 

[chicadehuskers]

could anyone more familiar with health insurance tell me if this is good or not? how does it compare to what you havE?

Low Option High Option
Plan Name Blue Cross Blue Shield Blue Cross Blue Shield
Community Blue PPO Community Blue PPO
Plan 4 Plan 2
Deductible
1 Person - In Network/Out of Network $500/$1000 $100/$250
Family - In Network/Out of Network $1000/$2000 $200/$500
Copayment Percentage
In Network/Out of Network 20%/40% 10%/30%
Copayment Maximum
1 Person - In Network/Out of Network $1500/$3000 $500/$1500
Family - In Network/Out of Network $3000/$6000 $1000/$3000
Physician Office Visit Copayment $10 $10
Emergency Room Copayment $50 $50
Prescription Drug Copayment $15 Generic $15 Generic
$30 Formulary $30 Formulary
$60 Brand Name $60 Brand Name


Premium
Low Option High Option
Annual - Effective 8/1/05 to 7/31/06
1 Person $2,667.72 $2,955.60
2 Person $5,936.40 $6,584.16
Family $7,049.28 $7,826.64
Family Continuation $1,333.44 $1,478.04

Semi Annual - Effective 8/1/05 to 1/31/06
1 Person $1,333.86 $1,477.80
2 Person $2,968.20 $3,292.08
Family $3,524.64 $3,913.32
Family Continuation $666.72 $739.02

This is a decent plan, but you could pay about half the amount in premiums if you got a plan with a higher deductible. Depending on your current health status/prescription needs, if may behoove you to look for an alternative plan.

 

[flashMD]

yes. That is what that means. You're responsible for everything until you've paid off the deductible. Then your insurance company covers 80% of all costs beyond that amount, and you cover 20% (if it's an in-network provider).

ACTUALLY...you can still go see your physician for office visits JUST PAYING the copayment. The deductible comes in when you get labs, xrays, procedures ETC. So, in theory, you could go to your doctor as much as you'd like paying only your co-payment out-of-pocket, but once you need to get a test ordered or have a procedure done etc., then you must pay your $100/$500/$1000 deductible BEFORE the insurance company picks up the remaining 80%. Once you have paid your deductible, the plan covers %80 of all costs for the rest of the calendar year. Office visits are still your $10/$20 co-pay regardless of whether or not you have paid your deductible for the year.

 

[fun8stuff]

ACTUALLY...you can still go see your physician for office visits JUST PAYING the copayment. The deductible comes in when you get labs, xrays, procedures ETC. So, in theory, you could go to your doctor as much as you'd like paying only your co-payment out-of-pocket, but once you need to get a test ordered or have a procedure done etc., then you must pay your $100/$500/$1000 deductible BEFORE the insurance company picks up the remaining 80%. Once you have paid your deductible, the plan covers %80 of all costs for the rest of the calendar year. Office visits are still your $10/$20 co-pay regardless of whether or not you have paid your deductible for the year.

i was wondering this very thing... thanks for clearing it up.

 

[chicadehuskers]

ACTUALLY...you can still go see your physician for office visits JUST PAYING the copayment. The deductible comes in when you get labs, xrays, procedures ETC. So, in theory, you could go to your doctor as much as you'd like paying only your co-payment out-of-pocket, but once you need to get a test ordered or have a procedure done etc., then you must pay your $100/$500/$1000 deductible BEFORE the insurance company picks up the remaining 80%. Once you have paid your deductible, the plan covers %80 of all costs for the rest of the calendar year. Office visits are still your $10/$20 co-pay regardless of whether or not you have paid your deductible for the year.

sorry. I misread the question...I thought you were asking about co-insurance, not copayments. So, yeah...ditto! You will also be billed for any additional costs of the visit not included in the co-pay. For example, I pay a $25.00 co-pay for each office visit (at the time of the visit). I am then billed for the additional $35.00 for the remaining cost of the office visit, plus whatever lab costs, etc. need to be paid. The latter amount(s) is then applied toward the deductible. There have been instances where an office visit was covered entirely by the co-pay at a different clinic. It just depends on the clinic you go to. Then again, my copayment is just a flat $25.00 fee...maybe it's different if it's a percentage copayment. I had a difficult time understanding the original post in that area. Even if you go to a preferred provider, the costs of the services will vary, but cannot exceed a pre-approved cost arranged between the provider and the insurance company.

Like I said before, this is a pretty good plan. But if you want to assume you will rarely need to go to the doctor and probably won't need to be in the hospital, you could definitely pay less annually with a plan with a higher deductible...these higher deductible/lower premium plans usually don't have co-pays per office visit either. It all depends on how much you can afford and how much risk you're willing to take on your health. It's somewhat of a gamble I suppose, but one I'm certainly willing to take at this point.

Sorry if you already knew all this. I didn't know if you were familiar with how health insurance worked or not. I wasn't until I had a kid and had to pay attention.