I was wondering when she...

[Arathena]

It's the law in at least one US state already right?

Massachusetts I think. And I find nothing wrong with mandatory health insurance, as long as its at the state level. Its something I believe is manifest in a state's right to manage itself. The Feds though, should stay out of it.

Because, of course, it would be easy-peasy to, say, deal with the various legal problems that might come from treating the resident of one state in another state.

.. The problem is what? Provider files a claim, it goes to the extra-territorial division of the home state, they negotiate a while, and it's done. Home state don't provide? You get the bill. Yes, there are always bureacracy issues. It is arguable as to which is the better choice.

And yes, it's law in Massachussetts, that you have to go out and buy health care "insurance" from a private or semi-private provider. The people that are feeling the bite the worst are the folks above the poverty level and beneath the 50-75k per earner level. It is a massive, regressive tax, and the people who need the help the worst are the ones that can afford to pay for it the least. If you are single and earning over $30,000 per year, you are also now being forced to pay a variable poll tax between $3,000 and $6,000 per year. If you elect not to pay a communal health care payment company, then you are socked on your taxes for half the cost of the cheapest communal health care payment company. If you earn more than $10k per year, you still get to pay your choice of the two new regressive taxes, just a tiny bit less. What part of a 20% tax on a poor person's income is supposed to help him? Taking the gamble that he'll be one of the 10% of people that consume 90% of the health care expenses that year, while putting him behind the eightball on his rent and grocery bill regardless? Well done, Massachussetts. Well done indeed.

Yeah, I'm pissy about it. But that's because I spent the last three years uninsured myself. My grand total healthcare bill over those three years? 4 doctors visits at $60 each, 2 runs of Amoxil at ~$30 each, 1 run of augmentin at $120, 1 run of Levaquin @ free from the pharmacuetical sample bin, probably worth about $100. Approximately $520. Cost of "insurance" to cover that, with a reasonable deductable? $10,800. Three cheers for the communal healthcare payemnt corporations. The system is broken at every level. I despise the fact that I do not think that anyone but the feds can do anything useful about it, because I do not think that the feds have or should have that authority.

[Ddrak]

My grand total healthcare bill over those three years? 4 doctors visits at $60 each, 2 runs of Amoxil at ~$30 each, 1 run of augmentin at $120, 1 run of Levaquin @ free from the pharmacuetical sample bin, probably worth about $100. Approximately $520. Cost of "insurance" to cover that, with a reasonable deductable? $10,800.

Note that none of that would have even met the deductible in any health care plan I know of, so you'd *still* be out of pocket $520 on top of the insurance costs.

Dd

[Harlowe]

Most of the healthcare plans I've been on here (BSBS, Medica, Healthpartners) didn't have a deductable for office visits or what they considered preventative "well-care" (you just have an office visit co-pay of around $20-$25) nor for prescriptions (co-pay around $15-$18). The deductable came into play when you had surgey (I think the split was 80/20 with a max out-of-pocket around $2,000). Monthly single coverage premium being anywhere from $0 (company paid the entire premium) to $40 a pay period.

[Finglefinn]

I wouldn't accuse my employer of collusion. They really don't have anything to do with the problems inherent with the insurance company. However, I did call a meeting with my CFO, HR Manager and a couple other Admin peeps to vent my frustration with the current health insurance company we contract with. Well see what happens in the spring when we review our insurance.

[Ddrak]

My coverage at the moment (United Healthcare through Rockwell Automation):

http://www.chase.net.au/ushc-ppo.pdf

Basically we have to use up $525 worth of doctor's visits that aren't an annual checkup before they start paying, and then only 80%. The plan is complete shit. If you've never had that sort of deductible, Harlowe, then I'd guess you've worked for small companies or the government?

Our company runs a self-managed insurance plan (ie they fund it and underwrite it themselves) so their primary interest is keeping the cost low. They've happily admitted this when they were shopping around for the "best" plans to offer us - their idea of "best" was returning maximum profit and minimum payouts.

Dd

[Finglefinn]

Ours revolves around network and non-network providers. Just another hoop providers have to jump through, and let me tell you, the hoop involves some 50 pages of forms, documents and 3-6 month approval process. And just because you go through the process doesn't mean that you are automatically approved for becoming a network provider.

Here's my deductible breakdown cut-and-paste from my provider website (Great-West Healthcare).

Medical Family Deductible
NETWORK $750
NON-NETWORK $1,500

Medical Individual Deductible
NETWORK $250
NON-NETWORK $500

Medical Inpatient Hospital Per Confinement Deductible
NETWORK/NON-NETWORK PER ADMISSION $250


Fortunately, I guess, co-pays count toward the deductible.

Medical Preventive Care Adult Office Visit Copay
NETWORK PER VISIT. $20
Medical Preventive Care Child Office Visit Copay
NETWORK PER VISIT. $20
Medical Preventive Care Infant Office Visit Copay
NETWORK PER VISIT. $20
Medical Emergency Room Hospital Copay
NETWORK PER VISIT. $50
NON-NETWORK PER VISIT. $50
Medical Office Visit Copay
NETWORK PER VISIT. $20
Medical Specialist Office Visit Copay
NETWORK PER VISIT. $20
Medical Outpatient Hospital Surgery Facility Copay
NETWORK PER VISIT. $250
NON-NETWORK PER VISIT. $250

Then once the deductible is satisfied, depending on the service and provider, my insurance pays between 70% and 100% of the total cost. And just about everything that is non-emergency as long as you are in the network is 90%. Preventive care, regular office visits, etc... all the normal stuff that is cheap and easy is 90%. If you are referred to someone outside the network, its 70%. This is where I really got mad with this last situation. My wife was referred outside the network to the only provider within 125 miles. And the insurance company decided to pay $0. Fuckers.

[Arathena]

My coverage at the moment (United Healthcare through Rockwell Automation):

http://www.chase.net.au/ushc-ppo.pdf

Basically we have to use up $525 worth of doctor's visits that aren't an annual checkup before they start paying, and then only 80%. The plan is complete shit. If you've never had that sort of deductible, Harlowe, then I'd guess you've worked for small companies or the government?

Our company runs a self-managed insurance plan (ie they fund it and underwrite it themselves) so their primary interest is keeping the cost low. They've happily admitted this when they were shopping around for the "best" plans to offer us - their idea of "best" was returning maximum profit and minimum payouts.

Dd

The communal health care payment plan at the company I am starting at is pretty much the same as Finglefinn's. It is hard to call it a small company. Under it, I would have paid $~80 direct... and $2430 of my money to the insurance company. I still lose on balance, but now I only have to have my ribs cracked or my nose broken once a year to recoup the money.

[Embar Angylwrath]

My coverage at the moment (United Healthcare through Rockwell Automation):

http://www.chase.net.au/ushc-ppo.pdf

Basically we have to use up $525 worth of doctor's visits that aren't an annual checkup before they start paying, and then only 80%. The plan is complete shit. If you've never had that sort of deductible, Harlowe, then I'd guess you've worked for small companies or the government?

Our company runs a self-managed insurance plan (ie they fund it and underwrite it themselves) so their primary interest is keeping the cost low. They've happily admitted this when they were shopping around for the "best" plans to offer us - their idea of "best" was returning maximum profit and minimum payouts.

Dd

That's a shit plan, Dd, as you said. The pricing structure is draconian, and actually encourages people to NOT see the doctor unless its a full blown crisis or emergency. And beware of any heath plan from a company that "self-funds".

[Embar Angylwrath]

Just for shits and grins, I'd appreciate a little feedback on the health plan I offer our employees.

We pay for 100% of the premiums;
Employees have a choice of four different networks;
Employees can choose a HMO or a PPO in each one of the four networks;
PPO has unrestricted doctors, but going out of network ups the percentage of cost sharing by the employee (paid to the doctor, not to us)
HMO is usually a $25 co-pay on doctor visits, $50 co-pay for hospital, $10 co-pay for prescription medication. Max out of pocket annual is $2,000 I think, and co-pays count towards the deductible amount. No requirement to meet annual deductible amount before insurance kicks in. It's pretty much a "pay your co-pay and percentage" type of plan.
I think the biggest percentage is 50%, and that's for stuff like prosthetics. Most routine and emergency procedures are paid at the 80%-100% level.

So.. for all you out there.. how does this plan rate? About average?

[Lurker]

That plan is about as good as it gets, Embar. I think it's damn near identical to what State employees get in CA. Nicely done.

[Finglefinn]

Yeah, that's a good plan. I'd take it over mine in a heartbeat. Especially since you pay the premiums for your employees. I pay 45% of the total premiums, which is equal to $8,544 per year plus copays and whatever percentage does not get paid. And then the whole deductible issue...

I think I'll look back at all the money we have spent this year on health care and see what was out of pocket vs what the insurance company paid. Hrmm...

[Ddrak]

Well, I only get to pay about $4k/yr for the privilege of my plan. And Embar's plan makes me cry it's so good.

Still think employment and health care needs to be separated.

Dd

[Embar Angylwrath]

I really am confused guys, because some of you are paying more out of your pockets for a plan that costs me only about $300-$400/month per employee (add $60 for dental/vision).

Oh.. one thing I wasn't clear on.. we only cover the employee. We will allow spouses/dependents, but the cost is on the employee for that. However, if they budget right, and don't go for the super-duper most expensive plan, they can cover an entire family for about $600/month, and we pay the first $450/month, so out of pocket for a employee with a spouse and unlimited dependents is $150 max.

And being a small company, we can usually find a way to cover the $150, if we need to and the employee is worth it.

[Ddrak]

Beats me, Embar. I suspect the insurance companies that deal with small businesses like yours are much more competitive and lean than the ones that deal with the larger companies and can take the CEO golfing to win contracts.

Dd

[Finglefinn]

Mine's a group plan based on the membership of hundreds of people. I have medical, dental and vision coverage. Also, my wife and son are on my plan, and in another couple weeks, a daughter. However, when we add the new baby, the cost will not increase. Since I have the whole family on the plan, I probably have a significantly higher premium that what you are used to seeing, Embar. Also, the more seniority I have with the company, the more of the premium they pay. My portion of the premium decreases 10% per year. It will decrease to 35% in four more months. The lowest will be 15% in 2010 if I'm still with this company.

[Partha]

I really am confused guys, because some of you are paying more out of your pockets for a plan that costs me only about $300-$400/month per employee (add $60 for dental/vision).

Well, yes. They're not the ones providing the plan, they're just the ones paying for it. Someone's making a killing.

[Klast Brell]

Looks like you may be able to add california to that list as well.
http://www.npr.org/templates/story/stor ... d=14556328

P.S. Enjoy the source

[Embar Angylwrath]

Mine's a group plan based on the membership of hundreds of people. I have medical, dental and vision coverage. Also, my wife and son are on my plan, and in another couple weeks, a daughter. However, when we add the new baby, the cost will not increase. Since I have the whole family on the plan, I probably have a significantly higher premium that what you are used to seeing, Embar. Also, the more seniority I have with the company, the more of the premium they pay. My portion of the premium decreases 10% per year. It will decrease to 35% in four more months. The lowest will be 15% in 2010 if I'm still with this company.

I read my post, and I think I was unclear. For single coverage of an employee, the cost is somewhere between $300-$400 (depends on what choice the employee makes on the plan). We cover $450/employee. If the employee wants his/her family covered, the cost is about $700 for employee+wife+unlimited dependents. So that employee pays $150/month for health insurance for his/her entire family.

Bottom line, no matter who pays:
Single employee: $5,400/year max
Entire Family: $8,400

Those numbers sound very close to what you guys are paying out-of-pocket. Just my guess here, but it sounds like the compnaies you work for are pushing the entire cost of the plan on to the employees. The discrepancy in costs might be covered in "rebates" the insurance company makes to the purchaser. For example: buy this policy for $15,000/employee per year, and if the aggregate of employees in the plan have less than $10,000,000 in claims over the year (they never do), then we rebate $7,000.

Its a way for employers to push the real cost onto employees, but get their contribution back at the end of the year.

[Finglefinn]

Thanks for the info, Embar. I'll bring that up at another meeting we're going to have next week. Sounds like we are getting screwed.

[Ddrak]

Those numbers sound very close to what you guys are paying out-of-pocket. Just my guess here, but it sounds like the compnaies you work for are pushing the entire cost of the plan on to the employees.

I'm sure they are. We get this big song and dance about how much the company is putting into the fund on our behalf, but really the fund just comes from general working capital and they just put enough in to keep the balance relatively constant (like I said, our plan is self-funded and UHC is really just an administrator). Hearing the numbers directly from you pretty much confirms that.

Dd