Tilted Forum Project Discussion Community - View Single Post - Health Insurance Questions (Individual plan vs. employer's plan)

kutulu · 11-19-2004, 02:27 PM

I'm having a similar issue. My provider that my company uses (a PPO) have had some extreme rate increases. Coverage for me, my wife, and our newborn is 1,166/mo. After the portion that my employer pays, my responsibility is about 640/mo (more than what I pay for rent). Our deductibles are 500/1500 (network) and 1500/3000 (non-network).

Now they are looking into a plan with the same provider with really high deductibles (2500/5000 ded, 2000/4000 out of pocket). My portion of the premium would be 402/mo. If you look at the premium only, it seems great but the difference in the deductibles are huge. To counter this, they would offer what is called a "Health Savings Account" (HSA) I'd contribute as much as I wanted (tax free) and that money can be used to cover the heathcare costs that insurance doesn't cover.

This works if you have the money in there but until that money is in there you are fucked if something happens because of the high deductibles and out of pocket expenses. If I wanted to get to the point where my deductibles and out of pocket expenses were the same in the event of an emergency, I'd need to put up to $9,000 dollars into my HSA. If I only put in the difference between the two plans, it would take four years to get that much money in my HSA.

Obviously, myself and the other employees were not happy with this. The plan costs us less per month but unless we put in a lot of our own money we'd be screwed if anything ever happened. It's basically the company lowering their costs at the expense of the employees.

I started looking into individual plans. One company I came across was health.net. It is also a PPO with the close to the same deductibles, out of pocket, coverage rates of the plan we currently have (the low deductible plan). The only difference in out of pocket expenses seem to be copays that are slightly higher. There is a huge difference in the premiums though. Based on their rate sheets, I can cover myself, my wife and our newborn girl for about $424/mo.

Something seems wrong here because the rates from health.net seem way too low. I'd be paying $424/mo for a plan that is almost the same as the plan that my employer and I pay almost $1200/mo (640/mo for me). The rate sheets say nothing about how the rates are subject to underwriting.

It could be possible that the woman running our HR department isn't doing a good job finding good care for a good price but it just doesn't make sense.

Has anyone dealt with health.net? Any advice?

11-19-2004, 02:27 PM	#1 (permalink)
kutulu Junkie	Health Insurance Questions (Individual plan vs. employer's plan) I'm having a similar issue. My provider that my company uses (a PPO) have had some extreme rate increases. Coverage for me, my wife, and our newborn is 1,166/mo. After the portion that my employer pays, my responsibility is about 640/mo (more than what I pay for rent). Our deductibles are 500/1500 (network) and 1500/3000 (non-network). Now they are looking into a plan with the same provider with really high deductibles (2500/5000 ded, 2000/4000 out of pocket). My portion of the premium would be 402/mo. If you look at the premium only, it seems great but the difference in the deductibles are huge. To counter this, they would offer what is called a "Health Savings Account" (HSA) I'd contribute as much as I wanted (tax free) and that money can be used to cover the heathcare costs that insurance doesn't cover. This works if you have the money in there but until that money is in there you are fucked if something happens because of the high deductibles and out of pocket expenses. If I wanted to get to the point where my deductibles and out of pocket expenses were the same in the event of an emergency, I'd need to put up to $9,000 dollars into my HSA. If I only put in the difference between the two plans, it would take four years to get that much money in my HSA. Obviously, myself and the other employees were not happy with this. The plan costs us less per month but unless we put in a lot of our own money we'd be screwed if anything ever happened. It's basically the company lowering their costs at the expense of the employees. I started looking into individual plans. One company I came across was health.net. It is also a PPO with the close to the same deductibles, out of pocket, coverage rates of the plan we currently have (the low deductible plan). The only difference in out of pocket expenses seem to be copays that are slightly higher. There is a huge difference in the premiums though. Based on their rate sheets, I can cover myself, my wife and our newborn girl for about $424/mo. Something seems wrong here because the rates from health.net seem way too low. I'd be paying $424/mo for a plan that is almost the same as the plan that my employer and I pay almost $1200/mo (640/mo for me). The rate sheets say nothing about how the rates are subject to underwriting. It could be possible that the woman running our HR department isn't doing a good job finding good care for a good price but it just doesn't make sense. Has anyone dealt with health.net? Any advice?