Health insurance date

Miriam George

[font size="1" color="#FF0000"]LAST EDITED ON 10-11-02 AT 02:12PM (CST)[/font][p]Would any of you be willing to share basic benefit schedule of your health plan and what the employee's contribute to the cost? I.E.: What do they pay for single plan? What do they pay for family?

We have no up-front deductible if one uses network providers. Instead we have co-pays - like $200 on a hospital bill (and no 80/20 sharing of the balance of the bill). All salaried employees pay absolutely nothing for their healthcare or for their dependents.

Although this sounds great, health costs are killing us (we are self-funded). We need to see how we compare with other businesses.

Nat

Unfortunately, I think almost all companies are in the same boat when it come to health care costs. Employees are having to absorb more of the costs both out of their paychecks and out of their pockets with increased deductibles, co-pays and co-insurance. Our company pays $109.13 per pay period toward employee's coverage. The following is a list of what our employees pay per bi-weekly pay period: Employee only coverage $20; employee/child(ren) $77.89; employee/spouse $168.79 and family $222.54. We feel lucky that our premiums only went up 11% this year - probably will not be as lucky next year. Our main problem is that there is only one insurance company in our area that will even quote us because of our industry - long term care. We use to be self funded but found that we were too small to afford it. You might want to research the advantages for going fully insured. We found a good broker who gets in there and fights for smaller increases. Hope this helps.

Don D

[font size="1" color="#FF0000"]LAST EDITED ON 10-14-02 AT 12:43PM (CST)[/font][p][font size="1" color="#FF0000"]LAST EDITED ON 10-14-02 AT 12:41 PM (CST)[/font]

Salaried employees and the entire family are covered on day one and have no cost for health, dental and vision. 1000 out of pocket, 250 deductible up to three, basic 80/20, PPO with virtually every provider in it.

Hourly employees and the entire family are covered on day one and pay 15 per week for a similar plan.

Drugs on both plans are 80/20 rather than a copay. We are also self insured, so we are not 'purchasing a policy', rather we tell Blue Cross, the Administrator, what our plan's options and policies are.

hrqueen

We have a PPO self insured medical plan, with a $15 co-pay for doctor's visits, $250 deductible, 90/70% and drug copay of $7 generic, $15 and $30. Our employees pay $8.53 per week employee only, $20.20 per week employee & spouse, $17.85 per employee plus one child, and $25.70 for full family.

Pork

Our is also a co-pay $10.00 per visit for PPO provided office visits. $200.00 deductable and 80/20% for all care (specialist beyond the office visit) up to $1000.00 out of pocket. $400.00 for outside of PPO care and a 60/40 split up to $2000.00 out of pocket. Emergency room visits are at the same $200.00 & $400.00 deductable and split based on in the network or out of the network for hospitol care unles it is determined that a true emergency was the case and there was no other medical facility to handle the case available.

Ours is also a self funded program with a 3rd party administrator. Our salaried employees pay the same as our non-exempt employees $12.00 per week for single and $41.50 per week for family coverage. Our plan is effective after the 60 day orientation period and the 1st day of the next month. We do not take any premium payments until after the coverage has begun. We pay the full premium and deduct weekly under our cafeteria plan before taxes are calculated thus saving the employee additional money.

Our third party administrator is an outside source. In a previous company in which I was the HR, I had a full time administrative nurse who handled my premiums payment and the administration of the plan/claims. By having a full time nurse we got the benefit of a nurse on duty each day plus saved the 3rd party administrator fee (lots of bucks there, enough to pay the for the computer program and her salary and supplies + saved an additional $75,000.00). She cut our claims handling fee and time from 7 days to 48 hours per claim. Additionally, we were able to establish a bonus program for the members, which "bought back from the employee" all claims not processed toward the $200.00 deductable each year. The first year, we bought them back at a rate of .25 to the dollar. The program was so successful that we raised the amount to .50 per dollar in the 2nd year. In the 5th year we were programmed to raise the buy back to .75 per dollar, but I went through a RIF and do not know if it continued.

The biggest savings was an added attraction all of a sudden we began to realize a multitude of strange hospital charges. Like a "breast plate" issued to a employee during a delivery of a new borne $357.00. It never happened and the charge was reversed and recovered as income. It was a real "eye opener" we even began to review old cases for wrongful charges and collections, another positive program of recovery. Had we not had the nurse who had the reference material and coding to discover crazy things like that, we would have continued to pay our bills as expected and never know the difference. Self insured with your on inside administrator is the way to go.

Good Luck, Pork