Originally Posted by
Bozo the pilot
No- you have to
say that you've run a marathon (or half) to get the full wack. There are multiple things to check off and it's the honor system. With the seed money, Im nothing out of pocket in 20 months, but we're a healthy family with just preventative visits as well as minor stuff.
Anything major costs you big- Birth/illness. An ER visit is 300.00 immediately.
I would say it's cheap to have, but expensive to use so it's basically a major medical plan. (Disaster insurance)
Please correct me if Im wrong here guys. My wife handles this stuff.
Cheap to have and expensive to use sounds about right, and I'm on the Green plan. Really, especially this year, the lines got blurred between the two plans. The BIGGEST difference is that on the Green plan, if you have one person that needs major medical stuff, the 20% co-insurance kicks in when they hit their individual deductible rather than the family deductible. The co-insurance won't kick in on the Blue until the family deductible is met. Honestly, with the higher premiums on the Blue plan, it should be the other way around, but I don't write those checks and make those deals.
This year we maxed out the FSA, plus the seed and maxed out the Healthy Rewards. Did the same last year, and it wasn't too bad since my wife was the only one that went in for three surgeries. Nothing past the regular check ups for me and my kid. This year? Oh hell. My wife has been in the hospital once and my kid twice. Add that to the on going stuff from the past two years with my wife, and we're all the way through the seed money, healthy rewards and the FSA. It's not even halfway through the year yet. We've still got a couple of grand to go until we hit the max co-insurance for the family. My wife is probably just under a grand on her max co-insurance for the individual. To make matters worse, a lot of offices won't do the proper follow up or the insurance's system won't be updated properly, and you wind up getting charged the full amount rather than 20% (or zero if you're over the limit) because they see the word "deductible" on your card. At best you might get a refund check in the mail a few months down the road. Most places will just toss a credit on your account and hope you never come back in for anything. I'm still in a fight for overpaid funds to a doctor's office from last year even after sending in multiple explanations of benefits being sent in, etc, etc.
Oh, and if you've already hit all that and still need to go to the emergency room, it's still $300 since it doesn't count towards the deductible or the max co-insurance. It's a separate deal altogether. So, if you're bleeding out at 1 am, try to keep it patched up until you can go see your primary doctor or one of the critical care places opens up at 8 am.
PayFlex (the people that administer the FSA/seed/healthy rewards accounts) are on my last nerve. They turned off my card twice and keep asking for "proof" that the charges from places with "medical," "hospital" and "cancer center" in their names are legit.
I defended this insurance for a little bit in the beginning, but the more I use it, the worse I see it is. It's pretty bad when I think back on the heath insurance I had at my regional and actually MISS it.....