It’s Benefit Enrollment Time – Legal, Pet Insurance and Lots of Little Perks

This is the final post of a series of posts on choosing benefits.  Today I will look at the ins and outs of the offered Legal Plan, Pet Insurance, Discount Programs and the rest for tomorrow.

In addition to all of the other great benefits, Large Conglomerate offers an array of add-on benefits.

Hyatt Legal Plan – offers unlimited telephone advice and consultation with a participating Plan attorney for covered services including:

  • Family law including premarital agreements
  • Wills and estate planning
  • Traffic and criminal matters
  • Real estate including sale, purchase or refinance of primary residence, and eviction and  tenant problems
  • Identity theft defense
  • Tax audits
  • Immigration assistance
  • Security deposit assistance for tenants
  • Boundary or title disputes
  • Property tax assessment
  • Zoning applications
  • Protection from domestic violence

You get all of that for $15.75 per month, or $189 per year, and it covers the employee and eligible dependents.

We have two lawyers in the family, so I’ll be skipping this.  That said, if you think you’ll need an attorney in 2009 for any of the above items then it would be worth finding out about.  Me?  I’d rather use that money towards a Personal Liability Umbrella.

So, this is a no.

Pet Insurance – through Veterinary Pet Insurance (VPI), they direct bill you for coverage.  We’re offered a 5% discount, and you have to click on the details button to find out that the discount applies to the premium of the base policy only, it does not apply to the Lost/Found Registration or optional coverage such as the Vaccination & Routine Care Coverage or the VPI Cancer Rider. Can not be combined with other discounts.

Woo. Hoo.

Birds, dogs, cats and other animals are covered.  Features include:

  • Choice of three different plans
  • Discounts for 2 or more pets enrolled
  • Routine care is an optional coverage
  • Helps with lab fees, treatments, prescription, surgery or more
  • Use any licensed veterinarian

I did an online quote and for my six-year-old mixed breed it ranged from $16.77 per month for their basic plan with no increased wellness coverage to a whopping $52.40 per month for their premier plan with increased wellness coverage.

Doing the math, that’s between $201.24 and $628.80 per year.  This dog, luckily, has not cost us a cent in veterinary bills for the past four years (We have two friends that are veterinarians, so get advice on the phone on the few occasions needed).  So even if we got a hige bill this year unless they cover $800 of it we’re ahead.

All that said, my beloved Jonah cost me over $200 per month with his Cushing’s Disease, thyroid problems and epilepsy.  Most plans won’t cover those things anyway.

Also a no.


Employee Assistance Program – supplies confidential, professional assistance with a wide range of work/life issues.  Information, counseling and referrals are provided for a wide range of needs.  I’m sure someone uses this service, and I’m glad it’s there for them.

Free, but no thank you.

Back-Up Care Advantage Program – Provides safe, affordable and reliable back-up child and adult/elder care services to employees and their families.     It’s a great benefit because it offers people an alternative when schools are closed, regular providers are on vacation or illness.  You can use home or center-based care at a very discounted rate.

  • Center-based care is $15 per child per day, $25 maximum for two or more children
  • In-home care is $4 per hour during weekdays  and $6 per hour evenings and weekends.
  • Medical care is $50 per hour
  • You must register.  Reservations are required, but they probnably have some last-minute availability for illnesses.  You can call 24/7.

I had to scramble earlier this year when I had to take my Dad for surgery.  I’m not sure how comfortable I am with strangers taking care of Son (he’s never had a babysitter), but I may check out the nearest center just in case something like this pops up again.

Health Advocate –  Helps employees and their faamilies navigate the health care system – an invaluable help when a serious illness strikes.  And it’s available to all active employees, spouses, parents and parents-in-law regardless of whether they are enrolled in one of Large Conglomerate’s health plans!

  • Clinical Support Services – care coordination among physicians and medical institutions and many other sevices
  • Administrative Supprt Services – including claims and billing assistance, fee negotiation with providers for treatment, and, when necessary, appeals assistance and information about alternative resources or coverage options.
  • Healthcare Coaching – helps particpiants manage their healthcare and treatment
  • Information and Service Support – helps members locate and arrange a wide array of services, access to experts for consltations and second  opinions, locate and arrange for special needs including transportation, and more.
  • Privacy – When a member takes advantafge of this service their provacy and health information is protected “to the fullest extent provided by applicable law”.

This is a terrific program I hope never to have to take advantage of.

Not now, but maybe someday.


Wellnessworx – a confidential and voluntary collection of tools, resources and personalized support to try to help you get/stay healthy.  It offers:

Health Risk Assessment (HRA) – a report card for your health.  You work on your own or with a Health Coach to formulate an action plan to target specific areas for improvement.

Healthways Health Coaching Program – using your HRA and looking at your filed health claims (Big Brother!), they may  contact us to work with highly trained coaches to support you in improving your health.

Healthways Condition Management Program – Helps those with common medical issues manage their conditions and improve their  health.

These guys send stuff to Husband all the time, which he valiantly ignores.  It’s all a little too Orwellian for me.

No thank you.

Nationwide Discounts – Large Conglomerate offers discounts to employees and their  families for a wide range of products and services.  We’re currently saving 10% on our cell phones, and I used their service to get a great deal on Husband’s MAC last year.  I check the website frequently for any new additions that we can take advantage of.  Also, through Aetna Wellness Products and Cigna Healthy Awards Discount Programs we can get discounts through our medical and dental providers for weight loss programs, gyms,  smoking cessation, alternative health care, vision, and hearing services.

Yes, thanks!

So, ladies and gentlemen, we’re done.  Now all that’s left is for me to go to the website and tell them my choices.  Since ther website is down I’ll have to wait, so it’s  a good  thing they extended the deadline.

I know this was boring as heck, but doing this forced me to actually read everything, something I haven’t done.  Ever.  I hope I’ve inspired you to do the same.

Read the rest of the series!

It’s Benefits Enrollment Time, Series Overview

It’s Benefit Enrollment Time – Medical Insurance Part 1 – Evaluating What You’ve Got

It’s Benefit Enrollment Time – Medical Insurance Part 2 – The Plans and What They Really Cost

It’s Benefit Enrollment Time – Dental Insurance and Why The Math is So Important

It’s Benefit Enrollment Time – Life Insurance a Bargain For Us

It’s Benefit Enrollment Time – Seeing the Vision Plan Clearly. Finally.

It’s Benefit Enrollment Time – Disability and Long Term Care Insurance are Good to Have

It’s Benefit Enrollment Time – Disability and Long Term Care Insurance are Good to Have

This is part of a series of posts on choosing benefits.  Today I will look at the ins and outs of our choices for Disability, and Long Term Care insurance.  I’d forgotten about Disability, so I’ll save  Legal, Pet Insurance, Discount Programs and the rest for tomorrow.


We are really so lucky that Large Conglomerate gives us access to so many benefit programs.  In addition to health insurance, dental insurance, vision coverage,and life insurance, we have other choices to make.

Disability Insurance – Besides medical insurance Disability is the most important coverage to have.  At least according to me.  My mother is disabled, and her life (and ours) would be much easier if she had purchased it.  My dear cousin was blessed with a policy that paid her 60 percent of her salary from the day she had to leave her job due to her Multiple Sclerosis more than fifteen years ago, and paid until she passed away from cancer a few months ago.  When I put in an offer on my house the first thing I did was to get a quote for Mortgage Disability Insurance.  Very, very important stuff.

There are two components to the coverage that Large Conglomerate offers:

  • Short-Term Disability – Pays for up to twenty-six weeks if Husband is sick or injured and unable to work for  more  than five consecutive business days.  Large Conflomerate picks up the cost of this completely.  Thank YOU!
  • Long Term Disability – Picks up at twenty-six weeks and covers 60% of Husband’s salary if  he becomes totally disabled.  There are lots of caveats and restrictions that will vary from policy to policy, but the bottom line is this is GOOD.  We have to pay for the Long Term Disability, and at $120 and change per month it’s hard to swallow but not as hard as it would be if we cold even find anyone to give Husband a policy.

A definite YES.


Long Term Care Insurance – Long term care insurance provides assistance with daily living activities such as bathing, dressing, eating, using the restroom and moving about.  Coverage applies either at home or in a facility, and it doesn’t matter whether you’ve been in an accident, sick or just dealing with the  effects of aging.

This is hugely important insurance to us, especially because we are older parents.  We don’t want Son to have to pay to take care of us, or take care of us himself.  If you want to know more of the reasons why we are very much sold on Long Term Care Insurance you can read the post I’ve already written about it.

That said, with only one income, and with both of is being 43 years old, we’re not ready to buy it yet.  And because we didn’t buy it at our first opportunity we’d have to provide the dreaded Evidence of Insurability.  Remember our old friend Diabetes?    Which means  they won’t issue the policy.  Pity, because we could have gotten a $200 per day benefit for $37.60 per month each.  That’s an excellent premium.

Rest assured we will take advantage of this option if we are ever given the opportunity (hopefully the job Husband gets when we finially move will offer it).

TIP: Something I’ve learned is to really read through all of your options when you get a new job and are eligible for benefits.   Know those items that give you a perk for signing up the first time – like not having to provide Evidence of Insurability.  That’s something that could really bite you in the  tush later.

Read the rest of the series!

It’s Benefits Enrollment Time, Series Overview

It’s Benefit Enrollment Time – Medical Insurance Part 1 – Evaluating What You’ve Got

It’s Benefit Enrollment Time – Medical Insurance Part 2 – The Plans and What They Really Cost

It’s Benefit Enrollment Time – Dental Insurance and Why The Math is So Important

It’s Benefit Enrollment Time – Life Insurance a Bargain For Us

It’s Benefit Enrollment Time – Legal, Pet Insurance and Lots of Little Perks

It’s Benefit Enrollment Time – Life Insurance a Bargain For Us

This post is part of a series on choosing benefits.  Today I will look at the ins and outs of our choices for Life Insurance.

The next item on the benefits agenda is life insurance.  Again, Large Conglomerate has several offerings.  Some are free, and some we must pay for.

We are offered:

  • Basic Life/Accidental Death and Dismemberment, with CIGNA Secure Travel
  • Business Travel Accident Insurance
  • Supplemental Life Insurance
  • Personal Accident Insurance
  • Dependent Life Insurance

All of these are provided at NO COST TO US:

Basic Life/Accidental Death and Dismemberment

  • Basic Life Insurance -standard life insurance with a death benefit of 1.5 times Husband’s base salary.
  • Accidental Death and Dismemberment (ADD) Insurance – pays an additional amount up to 1.5 times Husband’s base salary if the death is accidental, or if he suffers a dismemberment.  I haven’t seen the coverage for dismemberment, but these benefits are usually paid out as a percentage of the death benefit, and that percentage depends on what has been, er, lost.  I can’t find ours, but here’s a link to another policy and the coverage is likely similar.  It’s a bit macabre to read.  And no, it doesn’t cover if you lose your pinky toe.  Ouch.

CIGNA Secure Travel – This isn’t a death benefit.  As part of the ADD coverage, CIGNA Secure Travel provides emergency medical and travel services whentraveling more than 100 miles from home on company business or vacation.  I never really read this carefully before as Husband doesn’t travel for business, so I didn’t realize it covers vacations, too.  We can get help with pre-trip foreign travel assistance, interpreters, medical referrals, prescription refills, emergency travel services, and transportation of remains.    I will make sure I travel with their 800 number in the future.

Business Travel Accident Insurance

This is the death benefit coverage that pays if Husband dies or is dismembered while on company business.  Benefits vary based on the severity of the injury, but generally will pay up to four times his annual base salary up to 1.5 miillion.  We won’t have any problem staying under that  threshold.   It generally does not cover accidents to and from work.  It likely would provide coverage if he had to go see a client.  If Son and/or I accompanied Husband on a business trip we are also covered, with $50,000 for me and $25000 for Son.

All of that is free, so a very big YES, and  thank  you very much.

These benefits are offered at an additional cost to us:

Supplemental Life Insurance – Allows us to purchase an additional amount of life insurance from one to five times Husband’s salary.  Premiums are paid with after-tax dollars, so there is no tax benefit.  When Husband first started with the company we purchased this coverage, but only did three times his salary.   Then we found out he’s Diabetic. We’d love to increase it, but to increase coverage after you initually enroll you have to show Evidence of Insurability.  Yeah, not happening.  Rates are based on age and salary, and the policy is portable which means you can take it with you when you leave, as long as you are under  age 70.  That’s definitely what we’ll be doing, as buying new Life Insurance for Husband is just way too expensive.

Personal Accident Insurance – This is a new benefit this year.  Basically it’s just another accident policy, but it’s cheap ($.22 per $1000 of coverage), and they do not require Evidence of Insurability.  Pretty much any time I can buy coverage for him without evidence of insurability I do.  Thank you, Diabetes.

Dependent Life Insurance – Son and I are eligible for coverage, and we can choose several different amounts.  We did choose $50000 for me when we got married, which also gives us $10000 for Son.  Again the Evidence of Insurability monster rears it’s ugly head and we cannot increase this.  I have another $25000 in a paid up whole life policy I bought before I retired.  It’s not rated for age, so the $13 per month we pay isn’t bad.

So, yes, we are taking all of that, too.  The bottom line for us and life insurance is that we take as much as we can through work because we won’t be able to get anywhere near a decent rate with individual policies.  Yay aging.  Yay Diabetes.  Yay asthma.

Tomorrow I’ll wind up the series talking about Long Term Care, Legal, Pet Insurance, Discount Programs and the rest.

And then I’ll start writing posts that don’t put you all to sleep.  It will be a nice change.

Read the rest of the series!

It’s Benefits Enrollment Time, Series Overview

It’s Benefit Enrollment Time – Medical Insurance Part 1 – Evaluating What You’ve Got

It’s Benefit Enrollment Time – Medical Insurance Part 2 – The Plans and What They Really Cost

It’s Benefit Enrollment Time – Dental Insurance and Why The Math is So Important

It’s Benefit Enrollment Time – Seeing the Vision Plan Clearly. Finally.

It’s Benefit Enrollment Time – Disability and Long Term Care Insurance are Good to Have

It’s Benefit Enrollment Time – Legal, Pet Insurance and Lots of Little Perks

It’s Benefit Enrollment Time – Seeing the Vision Plan Clearly. Finally.

This post is part of a series on choosing benefits.  Today I will look at the ins and outs of our choices for Vision Care.

Husband has worked for Large Conglomerate for nearly seven years, and 2009 will be only the third year they’ve offered vision coverage.  I wear contact lenses, and I am a very serious, naughty overwearer.  I believe I’m supposed to wear each daily lens for two weeks before discarding them and using fresh lenses.  For me it’s often more like two months.  Or more.

I was thrilled when they started offering this coverage, as it had been twelve years since I’d gotten new glasses.  Granted, I only wear them at night, but the prescription was just not getting the job done, and my frames were past the point of repair.   Can you say tape?

The offerings this year are the same as that first year, and it is through VSP.   They offer the VSP Core Plan and the VSP Core Plan with Buy-Up.

VSP Core Plan

  • One eye exam every twelve months after $10 copayment.
  • $A 200 allowance applies to the cost of my contacts and the contact lens exam.

OR

  • One pair of lenses per year and one pair of frames every 24 months after $25 copayment.
  • A $200 allowance applies to the cost of the frames.
  • The cost of frames exceeding $200, additional prescription glasses and sunglasses all receive a 20% discount.


VSP Core Plan with Buy-Up is the same as the Core Plan except:

  • Two separate $200 allowances applies to the cost of my contacts and the contact lens exam.

OR

  • Two pair of lenses per year and two pairs of frames every 24 months after $25 copayment.
  • Two separate $200 frame allowances.

Or, you can do what I did that first year and get one pair of glasses and one set of contacts.

Husband has never worn glasses, so until this year I was the only one using it.  I chose the VSP Core Plan with Buy-Up that first year because I needed new glasses and contacts, and actually broke even (other than the premiums) because there was a rebate on the contacts which covered my copayments.


Pitfalls and PITAs and Good News

I know I could get glasses and contacts much cheaper than I can through the opticians covered under the plan, through Costco or Walmart or any number of online purveyors.  A lot cheaper.  But I’d still have to pay for an exam and a contact lens prescription, and it’s been my experience that doctors actually charged me for an eyeglass prescription of I wasn’t getting my glasses there.  Which really, really peeves me.

The biggest pitfall to this program is that they do not have any accounts with any of the discount retailers, which you would think would save them money.   Our optician gave me the reason for that when she told me that they do all of their own lensmaking, so it saves them a fortune.  And I’m sure they only reimburse a fraction of the retail price on the frames, too.   I have gone over the coverage limit and had to pay out of pocket.

On the other hand, last year the optician price-matched the lowest price I found online for the contact lenses.   With the rebate I wound up making money on the deal.

Last year and this year we skipped the Buy-Up and just did the VSP Core Plan. I actually have my appointment for this year’s lenses tomorrow morning (after 20 months I’m getting low on lenses).  I was contemplating letting the coverage go next year, figuring that I could do just as well through a discounter and that I probably would not need to buy lenses next year at all.  But then we found out that Husband needed glasses, for the first time ever.  Getting old has it’s challenges!

Because he’s diabetic we wanted to go to our Opthamologist, who is not on the plan (though other Opthamologists are).  We walked in to the optician (one of those people who are really, really good at their job and just accentuate the crappy customer service you get everywhere else) with a prescription and walked out with a pair of really killer titanium lenses with polycarbonate scratch-resistant lenses, glare protection (pretty important here in the land of the sun),  and clip-on sunglasses for $75 out of pocket.  That’s a pretty good deal that I don’t think I could have matched online.  Fantastic Optician also commented that VSP is the best Vision plan she’s ever seen, so that was an interesting tidbit, too.

So, let’s look at the costs for 2009.

VSP Core Plan 2009 Annual Premium: $85.32 (Note: I do not get the family plan for this, I select the Employee + 1 pricing.  Son does not need Vision Care, so why pay extra?)

Copayments:  $20

VSP Core Plan with Buy-Up 2009 Annual Premium:  $113.40

Copayments:  $20

So, bottom line is that now that Husband and I are both visually challenged this becomes an even better deal for us.   And something else occurred to me just this very second.

I’m thinking that perhaps we’ll do the VSP Core Plan with Buy-Up this year.  For an addtiional $28.08 ( that’s only $1.17 per paycheck – and paid with pre-tax dollars!)  I can get twice the amount of contacts and Husband can pick up a pair of prescription sunglasses, and  we can likely skip the coverage for 2010, and maybe even 2011 and save those premiums.

Oh, yes.  We will definitely be doing the VSP Core Plan with the Buy-Up this year.



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Read the rest of the series!

It’s Benefits Enrollment Time, Series Overview

It’s Benefit Enrollment Time – Medical Insurance Part 1 – Evaluating What You’ve Got

It’s Benefit Enrollment Time – Medical Insurance Part 2 – The Plans and What They Really Cost

It’s Benefit Enrollment Time – Dental Insurance and Why The Math is So Important

It’s Benefit Enrollment Time – Life Insurance a Bargain For Us

It’s Benefit Enrollment Time – Disability and Long Term Care Insurance are Good to Have

It’s Benefit Enrollment Time – Medical Insurance Part 2 – The Plans and What They Really Cost

This post is part of a series on choosing benefits.  Today I will look at the ins and outs of our choices for Medical Insurance.

Large Conglomerate gives us three choices for our Health Insurance, all through Aetna.  The drug plans are the same with all three choices, so they won’t be included in these breakdowns.

Aetna Select Plan – They don’t call it an HMO anymore, but that’s basically what it is.

Good News

  • They’ve removed the referral requirement – something that I always thought was a supreme waste of time and money for all concerned
  • No deductible or coinsurance
  • Inexpensive office visit co-payments ($15 primary care, $25 specialists)

Bad News

  • $542.04 per month family premium, the highest of the three.
  • Only network doctors covered.  No coverage AT ALL for out of network services, not even reduced coverage.  None.  Nada.

Cost Estimate for 2009

For the purposes of comparison I am going to use last year’s office visit copay total to give me an idea of my out-of-pocket costs for next year.  I am not going to include pharmacy benefits in these totals.

Out of pocket for the Aetna Select are the premiums and copays.  Last year I paid out $375 for non-pharmacy co-pays, so by adding in the annual premium of $6504.48, if things stay the same as last year I can expect to pay approximately:

Premiums:  $6504.48

Co-pays:       375.00 estimate

ESTIMATED ANNUAL COST:$6879.48

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Aetna Point-of-Service Comprehensive Plan – Somewhere between an HMO and a PPO, from what I can tell.  Insurers continue to change names in an effort to confuse us provide us with more options.

Good News

  • No referrals required
  • Choice of in-network and out of network care, though out of network costs are higher

Bad News

  • $530.98 per month family premium
  • $250 Individual / $500 Family in-network deductible, $750 Individual / $1500 Family out-of-network deductible
  • Pays 90% once your deductible is reached, with the maximum you pay  $1000 Individual / $3000 Family in-network coinsurance, $3,000 Individual / $9,000 Family out-of-network coinsurance
  • Office visits have the same co-pay  in-network as the Aetna Select, but out-of-network services have no co-pay are only covered at 70% after the out-of-network deductible is reached

Cost Estimate for 2009

Out of pocket for the Aetna Point-of-Service Comprehensive Plan are the premiums, deductibles, coinsurance and copays.   I am going to assume that we have no out-of-network services next year.

Premiums:  $6371.76

Deductibles:  $500.00

Co-pays:       375.00 estimate

ESTIMATED ANNUAL COST:$7,246.76

That doesn’t include coinsurance, which could add another $3000 to our in-network out-of-pocket maximum.  Going out-of-network could add another $10,000 (an extra $1000 for the deductible, and $9000 coinsurance), bring our our possible total out of pocket to $17,246,76!

Egads!  That a lot of money out of pocket!

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Aetna High Deductible PPO Plan with Health Savings Account option – This is a traditional PPO plan, with in and out-of-network coverage, but the deductible is high.  To offset that you can have a Medical Savings account.

The theory here is that if you are healthy and don’t use your insurance much, you can save money on your premiums by taking a high deductible, and putting money into a Health Savings Account (HSA) (not to be confused with a Health Care Flexible Spending Account),

Good News

  • No referrals required
  • Choice of in-network and out of network care, though out of network costs are higher
  • Large Conglomerate contributes $500 for Individual or $1000 for Family coverage to the HSA
  • Your own contributions to t he  HSA can be taken with pre-tax dollars.
  • HSA dollars can roll over from one year to the next, unlike a Health Care Flexible Spending Account (which requires that you use all the money yearly or you lose it)

Bad News

  • $507.46 per month family premium, the least expensive of the three (at over $500 I put all the premiums under Bad News!)
  • $1,500 Individual / $3,000 Family in and out-of- network deductible (and if Family plan the full Family plan deductible must be satisfied before any claims will be paid, unlike the Aetna Point-of-Service Comprehensive Plan)
  • Pays 90% once your deductible is reached, with the maximum you pay $3000 Individual / $8000 Family in and out-of-network coinsurance
  • Office visits are only covered at 90%, and only after the deductible is reached

Cost Estimate for 2009

Out of pocket for the Aetna High Deductible PPO Plan with Health Savings Account option are the premiums, deductible and coinsurance.

Premiums:  $6089.52

Deductible:  $3000.00

Less employer contribution to HSA: (-1,000)

ESTIMATED ANNUAL COST:$8089.52

That doesn’t include coinsurance, which could add another $8000, bringing our possible total out of pocket to $16,089.76!


We do have to remember that  money isn’t the only consideration for choosing your policy.  Large Conglomerate was kind enough to put together a comparison chart where many of the coverages are compared and contrasted, so we could see if there are any huge differences in coverage.  And there are some.  if Husband drives me crazy enough that I must seek psychiatric treatment, I’m limited to only 20 visits per year, and only 35 days of inpatient coverage.

Aetna Select certainly gives us less choices, but within the choices we have we pay less.  A lot less. In fact, if I were to have another child I’d pay $25.  That’s it.  

Looking at the coverages and the numbers the only choice we can responsibly make is the Aetna Select, which is $309.60 more than last year’s total of $6569.88. We’ll have to find that money somewhere.  But we don’t have to worry about deductibles or coinsurance, and even if our co-pays for the year doubled we’d still pay less than either of the other options.

So, that’s it.  Choice made.  Next up are the Flexible Spending Accounts. We don’t use the Dependent Care Flexible Spending Account since I am a stay-at-home Mom (nor do I have my parents as dependents, thank goodness!), but we ARE going to use the terrific Health Care Flexible Spending Account benefit to further reduce what our out-of-pocket expenses really cost us.  Join me next time as I figure out how much to contribute!

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Read the rest of the series!

It’s Benefits Enrollment Time, Series Overview

It’s Benefit Enrollment Time – Medical Insurance Part 1 – Evaluating What You’ve Got

It’s Benefit Enrollment Time – Flexible Spending Accounts Mean More Money in Our Pocket!

It’s Benefit Enrollment Time – Dental Insurance and Why The Math is So Important

It’s Benefit Enrollment Time – Life Insurance a Bargain For Us

It’s Benefit Enrollment Time – Seeing the Vision Plan Clearly. Finally.

It’s Benefit Enrollment Time – Disability and Long Term Care Insurance are Good to Have

It’s Benefit Enrollment Time – Legal, Pet Insurance and Lots of Little Perks

It’s Benefit Enrollment Time – Medical Insurance Part 1 – Evaluating What You’ve Got

This post is part of a series on choosing benefits.  Today I will look at our choices for Medical Insurance and how I will decide which route to go.

Most people, especially young people, don’t carefully consider their health insurance choices.  They’re young, they’ve never been sick, there’s other  things they’d rather spend their money on.

To those of you who say you’ve never been sick, well, no one has ever been sick until they get sick.

I’ve always worked for companies that offered excellent health coverage, so I didn’t really have to think about too much.  My last employer offered an excellent PPO (Preferred Provider Organization), and they paid 100% of the premium.  I was allowed to see any doctor I chose, and had to pay a $500 deductible and 80% coinsurance (90% if I stayed in network) with an out-of-pocket maximum of $3000 for the year.  Most years I never even spent more than my deductible.  The only year I came close was the year I had Son, and I maxed it out that year (a Cesarean Section will do that).  Still, by negotiating with the hospital and then being rewarded by my insurer for finding errors on the bill I was able to reduce what I actually spent to about $1800 (I really should write a post about that!).  Meanwhile, my friends with HMO’s paid $25 for their entire pregnancy.

I stayed home with Son for three months after he was born, and we’d decided that I would leave go back for six months before leaving permanently (we had delusions of grandeur that we’d be moving out of state).  Our income would be cut in half, so we already were reassessing all our expenses.  We’d added Son to Husband’s insurance (also a PPO) as soon as he was born because we knew I’d not be working long and because it was less expensive than adding him to mine.

I wound up leaving after  three months, and since the PPO they offered at the time was $200 more per month (for the three of us) than the HMO ,we went with the HMO.

Why am I telling you all this?

Step 1 in evaluating and choosing our medical benefit is to take a look at our lives, our current health, and our plans for the next year.

These are the factors that are going to influence our choices this year:

  1. Our financial situation – we are a one income household, and the economy is…challenged.
  2. Husband has diabetes,  meaning we’re going to use our policy for his treatment.
  3. Son has asthma, though I am hopeful that we will begin to see him outgrow it this year.
  4. I have some of my own health challenges that will rear their ugly heads again next year.  We need to plan for that.

Step 2 is to figure out how our current plan did for us last year.

  1. How much were the premiums?
  2. How many times did each person in our family go to the doctor this year, and how much did we pay for co-payments? We’ve been to the doctor or lab thirty-two times this year and paid $375  in co-payments.
  3. Were all our doctors on the plan, and were we happy with them? Yes, and mostly. We’re going to look for a new primary care physician that isn’t thirty miles away.  And there was the one  time that Son’s pediatrician diagnosed MY illness (that my doctor had missed, but when I went back and told her what he’d said she said,  “Hmmm.  Yeah.  That IS what you have…”).

Now that we know where we’ve been we can properly evaluate next year’s choices.  Tomorrow’s post will look at the actual plans, and what they will really cost us.

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Read the rest of the series!

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Read the rest of the series!

It’s Benefits Enrollment Time, Series Overview

It’s Benefit Enrollment Time – Medical Insurance Part 2 – The Plans and What They Really Cost

It’s Benefit Enrollment Time – Flexible Spending Accounts Mean More Money in Our Pocket!

It’s Benefit Enrollment Time – Dental Insurance and Why The Math is So Important

It’s Benefit Enrollment Time – Life Insurance a Bargain For Us

It’s Benefit Enrollment Time – Seeing the Vision Plan Clearly. Finally.

It’s Benefit Enrollment Time – Disability and Long Term Care Insurance are Good to Have

It’s Benefit Enrollment Time – Legal, Pet Insurance and Lots of Little Perks

Hospital Income Policy A Terrific Buy For My Family – How About Yours?

The following information is not advice, it’s just my thoughts and opinions. I’m just a girl on the web, not currently licensed in insurance or anything else in any state. You should absolutely seek the counsel of an insurance agent licensed in your state before taking any action at all. This is only a brief explanation of coverage. Modifications are applicable in some states. Coverages and programs discussed may or may not be available in your state.

Also know that I don’t work for State Farm any longer and am not being compensated in any way for this article. It’s just a good policy.

I love this policy. And them’s some strong feelings about an insurance policy. I promised you all I would tell you about it, so here it is.

I’m not sure if I’d have discovered this policy if I hadn’t been working for State Farm as an insurance agent. It’s not well publicized, but it can be a terrific part of anyone’s health insurance portfolio.

What is it?

If you’ve ever been hospitalized you know that there are expenses your primary health insurance just doesn’t cover. Additionally the inconvenience of simply being hospitalized means additional expenses for you and your family. Things like:

  • Deductibles and Co-insurance
  • Private Room and Private Duty Nursing Fees
  • Transportation
  • Child Care
  • Lawn & House Care
  • Meals Out
  • Pet Care

State Farm’s Hospital Income policy helps provide the money you’ll need to pay for those extra expenses when you’re hospitalized. It can offer you an ideal way to supplement your health insurance coverage.

If you are hospitalized for a covered injury or sickness (and really, there aren’t many exclusions) the policy pays the selected hospital income amount (mine’s $100/day*, but I wish I’d taken more!) for up to 365 days of confinement in a hospital.

One of the exclusions is for normal pregnancy and childbirth. However, complications of pregnancy and childbirth are covered. When I had Son I needed an emergency Cesarean Section, so my five day hospital stay was covered. Son had some minor complications so his stay was covered, too. He was automatically covered at birth as long as I added him to the policy (and paid the additional premium) within thirty days of his birth. It also covered his three day RSV induced hospital stay when he was 21 months old – the longest days of my life.

When Intensive Care is needed the policy pays an additional benefit equal to the hospital income amount not to exceed 14 days. So for me that means I get an additional $100 per day if I’m in ICU.

One of my former coworkers has a $200 per day policy. When her daughter was born six weeks prematurely she was in the pediatric intensive care unit for three weeks, then hospitalized another two. With her own hospital stay, her daughter’s hospital stay and the extra $200 per day she received for 14 of the 21 days her daughter was in intensive care my coworker received over five thousand dollars from her hospital income policy – enough so that she could stay home with her, unpaid, until her daughter was off a heart monitor and able to be placed in daycare so she could return to work.

Can you imagine the financial disaster she would have suffered if not for this spectacular little policy?

When Extended Care is needed the policy pays half the hospital income amount (so for me that would be $50 per day) for up to sixty days per calendar year while in a qualified Extended Care Facility. In most states extended care must begin within 14 days after at least a three day hospital confinement.

But that’s not all. And that’s not even my favorite part of the policy.

When you are injured accidentally the policy pays up to five times the hospital income amount (in my case up to $500) for x-rays or emergency first aid if received within 72 hours of the injury. If I have over $500 in emergency room or doctor costs, I get $500. If the bills are less than $500 I get whatever the bill amounts to.

I have used this portion of the policy many, many times. In the last ten years there have been at least three car accidents (none my fault!) that have ended in emergency room visits and one broken arm (on January 7th, so my $500 primary policy deductible had not yet been met). Each of those (and there may be more events I’m just not recalling right now) netted me $500.

There was also an incident, when Husband and I were trying to conceive Son, where I stepped wrong and broke a few toes. I wasn’t sure if it was just my toes or if my foot was broken, too, so I went to the ER (if I’m going to be in so much pain I may as well get paid for it!). I wouldn’t allow them to do X-rays (I could have been pregnant). The doctor assured me my foot wasn’t broken, taped my toes together and billed me $420. My primary insurance paid 90% (I’d met my yearly deductible, and my co-insurance was reduced because I went to an in-network hospital), so after paying my co-insurance I pocketed $378.

Isn’t that fab?

And if you have kids you know how often accidents happen. We’ve already collected from the policy twice for Son, including the incident last summer when he thought it would be fun to shove a rock up his nose. That sucker was wedged up there.

And there’s more.

When outpatient surgery is needed the policy pays the hospital income amount ($100 for me) for outpatient surgery not otherwise covered by outpatient benefits.

This is probably the part of the policy we’ve used most. Any outpatient surgery is covered. We’ve collected for all three of my colonoscopies and Husband’s one, his cardiac catheterization, three of my cyst removals, several mole removals, skin cancers. It even covers skin tag removal, which is so much of a nothing I’ve taken them off myself (isn’t aging sexy?).

So if I really needed some money one month I could, if I were so inclined, go to the dermatologist and pay my $25 co-payment, have her remove a skin tag or two and file a claim under my Hospital Income policy. I’d make $75 on the deal. And have fewer skin tags. Not that I’ve done that just because I’m short of money.

But I could.

Yes. I get paid to go to the doctor. Isn’t that smashing?

What else to like about this policy?

The benefits start from the first day of confinement. No waiting period!

The money is paid directly to you, unless you say otherwise. You decide how the money is spent. Use it to pay your deductible, you coinsurance or go on a trip to Tahiti. You decide!

The money isn’t taxable income. It’s insurance policy proceeds, so not counted as income (There may be some odd rule somewhere that I’ve never heard about that may make this taxable some minute fraction of the population, so please ask your tax advisor for a definitive answer. After all, if I wanted to know everything there was to know about taxes I’d have become an accountant like my father!).

Family coverage is available. You can cover just yourself, or add your spouse and kids. Remember that newborns are covered automatically as long as you notify the company and pay the premium.

It’s not expensive. We cover all three of us for about $280 for the year, and we’re oldish. The premiums will vary based on your age(s) and the policy amount chosen. I’ve not had a year yet that I didn’t collect more than I’ve paid. Of course if it was that way for everyone the company couldn’t offer it! Also know that the premiums can and do increase periodically as you age.

The policy is Guaranteed Renewable. Except in the event of fraud, material misrepresentation, nonpayment of premium, or expiration of the policy.

This policy is a great supplement to today’s high deductible plans, and also a great option for anyone with a HSA plan (State Farm also offers one of those). It should obviously not be your only coverage. If you have State Farm Auto and no other insurance with them you’ll also get a discount on your auto insurance for buying this policy.

You do have to medically qualify for the plan, and there are exclusions. The medical qualification is the only thing that keeps me from increasing our policy amount – with Husband’s diabetes and Son’s asthma we’d get denied. Dadgummit!

So call your local State Farm agent and get a quote. Even if you don’t have any other State Farm coverage. It’s definitely worth looking into.

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