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roz · 02-14-2005, 05:50 PM

Well, I'm not in my lousy company plan either.

Charlie's company is with Aetna. We have two PPO options, an out of area plan, and EPO (like an HMO). New for this year is the option to join a Consumer Driven Healthplan (CDH) with an HRA funded by the company to offset the higher deductible.

We are in the lower cost PPO and will pay $190.45 per month for family coverage. That also includes dental insurance. Office visits are $16 and Rx is $11 for generic/$21 for brand. There is a $263 per person/$790 family deductible and a 10% coinsurance with an out of pocket limit of $527 for individual/ $1579 per family. Aetna also manages the flexible spending account so it's all linked if you go through them. So, if you use them to go to the MD and pay the $16 co-pay, a few days later you get an email stating that your EOB is issued. Once you have $25 in expenses for the flex, they cut you a check. The only claims you have to file are for services outside the plan and for over the counter medications.

The CDH is new. The company provides a HRA in the amount of $1000 individual/$3000 for a family. Preventative care and Rx is not applied to that. The Preventative care is 100% paid and the Rx has a $10 generic/$20 preferred/$40 non-preferred co-pay. After the HRA is exhausted, the deductible is $500 individual/$1500 family. The coinsurance out of pocket maximum is $1000 individual/$3000 family. But if you are healthy and don't use the HRA, the unused portion carries over to the next year.

So, if you are healthy the CDH might be a good deal. Last year Charlie had his check up and because he is over 50 he had a colonoscopy. It cost us the $250 deductible plus the 10% coinsurance of $137. Other than co-pays for a few Rx, co-pays for office visits for check-ups, we had no expenses. With the CDH, we would not even have the co-pays, other than for the Rx. We would not have had to pay his deductible or coinsurance because we would have been well within our $3000 limit. So, about $450 in out of pocket expenses would have been saved. And we would have carried over $2550 to the next plan year. That would be added to the new allotment of $3000. So, even if we all got really sick or injured the following year, our maximum out of pocket would be $4500 (1500 deductible plus 3000 coinsurance). The balance in the HRA would be $5550, so we would still have $1050 to use for the next year.

Hmmmmmm.

The cost is relatively the same. So that's not the issue. So, I have to make a decision relatively quickly because their plan year is March 1-Feb 28.

Ashley, that plan is awesome. Most employers cannot afford that any longer!

Jan, many companies are moving to higer co-pays. People were running to the doctor for the slightest thing, driving up costs. At the last company I worked they had a $5 co-pay. A mother of four said that it was cheaper to take her kids to the MD than to the movies! I increased it to $15. I hear they increased it to $25 this year, but kept premiums level. I also instituted a Rx formulary. It saved a lot of money.

02-14-2005, 05:50 PM	#6 (permalink)
roz Jetgirls Ol' School Member Join Date: Oct 2003 Location: Philly Posts: 2,252 Recipes: Thanks: 0 Thanked 6 Times in 6 Posts	Re: Health Care Well, I'm not in my lousy company plan either. Charlie's company is with Aetna. We have two PPO options, an out of area plan, and EPO (like an HMO). New for this year is the option to join a Consumer Driven Healthplan (CDH) with an HRA funded by the company to offset the higher deductible. We are in the lower cost PPO and will pay $190.45 per month for family coverage. That also includes dental insurance. Office visits are $16 and Rx is $11 for generic/$21 for brand. There is a $263 per person/$790 family deductible and a 10% coinsurance with an out of pocket limit of $527 for individual/ $1579 per family. Aetna also manages the flexible spending account so it's all linked if you go through them. So, if you use them to go to the MD and pay the $16 co-pay, a few days later you get an email stating that your EOB is issued. Once you have $25 in expenses for the flex, they cut you a check. The only claims you have to file are for services outside the plan and for over the counter medications. The CDH is new. The company provides a HRA in the amount of $1000 individual/$3000 for a family. Preventative care and Rx is not applied to that. The Preventative care is 100% paid and the Rx has a $10 generic/$20 preferred/$40 non-preferred co-pay. After the HRA is exhausted, the deductible is $500 individual/$1500 family. The coinsurance out of pocket maximum is $1000 individual/$3000 family. But if you are healthy and don't use the HRA, the unused portion carries over to the next year. So, if you are healthy the CDH might be a good deal. Last year Charlie had his check up and because he is over 50 he had a colonoscopy. It cost us the $250 deductible plus the 10% coinsurance of $137. Other than co-pays for a few Rx, co-pays for office visits for check-ups, we had no expenses. With the CDH, we would not even have the co-pays, other than for the Rx. We would not have had to pay his deductible or coinsurance because we would have been well within our $3000 limit. So, about $450 in out of pocket expenses would have been saved. And we would have carried over $2550 to the next plan year. That would be added to the new allotment of $3000. So, even if we all got really sick or injured the following year, our maximum out of pocket would be $4500 (1500 deductible plus 3000 coinsurance). The balance in the HRA would be $5550, so we would still have $1050 to use for the next year. Hmmmmmm. The cost is relatively the same. So that's not the issue. So, I have to make a decision relatively quickly because their plan year is March 1-Feb 28. Ashley, that plan is awesome. Most employers cannot afford that any longer! Jan, many companies are moving to higer co-pays. People were running to the doctor for the slightest thing, driving up costs. At the last company I worked they had a $5 co-pay. A mother of four said that it was cheaper to take her kids to the MD than to the movies! I increased it to $15. I hear they increased it to $25 this year, but kept premiums level. I also instituted a Rx formulary. It saved a lot of money.