Дoбрый день
Это страховка для дочки. сейчас у нее индивидуальная от Blue cross blus shield.
Платим около 150 в мес - только что повысили примиум. Хочу что-нибудь дешевле
Вот что стоит на карте
Office visit copay - 25
Ded 1000/3000
Coin 1000/3000

Сюда входит дентал план, с фиговеньким покрытием. Знаю, что покрывают 5 офис визитов в год с копеем 25.
ВО-первых, что означает /вторая цифра в Ded 1000/3000 and Coin 1000/3000?

ИЗ Blue cross blus shield по запросу мне прислали письмо - планы подешевле:

1. If you decide to change benefit options and then wish to switch back to
your current plan or one with greater benefits you will be required to
re-apply for coverage and, if accepted, all applicable waiting periods
will apply. In addition, if your current plan is discontinued at the
time you re-apply, you would not be able to return to that plan.

2. Changing your coverage from Family or Individual/Spouse to Individual or
Individual/Child(ren) will result in the loss of obstetrical coverage.

3. If you are not currently enrolled in dental coverage, it cannot be added
at this time.

4. Covered Health Care Reform Preventative benefits are paid with no
patient responsibility when the services are provided by an in-network
provider. For more information concerning the preventive services
covered under Health Care Reform, please visit the website at
http://www.healthcare.gov/law/about/pro ... /list.html.

5. By making a significant change to your current benefit plan, your status
would change from grandfathered to non-grandfathered. Included with this
letter is frequently asked questions about grandfathered status.

Вот сами предлагаемые планы - мне нужна помощь, разобраться какой лучше по соотношению цена/покрытие.
Извините за много буков. Далеко не все сама понимаю.

_________________
Life in a cage cowering in fear isn't life at all. Let those who wish to cower, cower, let those who wish to live, live!

номер1

Affordablue has four options:

These options require the use of a Blue Choice Provider for maximum
benefits.

· $2,000.00/$6,000.00 deductible, 80/20 coinsurance to a maximum of
$1,000.00/$3,000.00 with prescription drug coverage*
*The prescription drug coverage has a $100.00 per person and $300.00 per
family deductible. After the deductible is satisfied, prescription drugs
are reimbursed at 50 percent of the allowable for the remainder of the
benefit period. You will need to show your card at the pharmacy to obtain
any discount that may be available and then submit your prescription claims
to Blue Cross and Blue Shield of Kansas.
The deductible starts over at the beginning of the next benefit period.

· $2,000.00/$6,000.00 deductible, 80/20 coinsurance to a maximum of
$1,000.00/$3,000.00 with no, prescription drug coverage.

After the deductible is satisfied, Blue Cross and Blue Shield of Kansas
will begin reimbursing at the 80 percent coinsurance percentage of allowed
charges for covered services until your coinsurance maximum has been
reached.

There is a $25.00 copay applied to each home and office visit up to a
maximum of 5 visits per person or 15 visits per family (of 3 or more) per
benefit period. Outpatient lab and radiology services are eligible at 100
percent of the allowed charge up to a maximum of $300.00 per person or
$900.00 per family per benefit period. After the maximum, these services
are subject to the deductible and coinsurance amounts.

An insured using a Non-Blue Choice Institutional or Professional Provider
or a Non-Blue Plan Preferred Provider will be required to pay 20 percent of
otherwise allowable amounts accumulated up to $2,000.00 per person and
$4,000.00 per family per benefit period. Deductible and coinsurance amounts
apply in addition to this 20 percent penalty amount.

The premium amounts are as follows:

Options | Medical | Dental
---------------------------------+----------------------------+------------------
$2,000/$6,000 - with drug | $112.80 | $25.57
coverage | |
---------------------------------+----------------------------+------------------
$2,000/$6,000 - no drug | $109.62 | $25.57
coverage | |

_________________
Life in a cage cowering in fear isn't life at all. Let those who wish to cower, cower, let those who wish to live, live!

номер 2: 50/50
This option requires the use of a Blue Choice Provider for maximum
benefits.

Affordablue 50/50 has two options:

$1,000.00/$3,000.00 deductible, 50/50 coinsurance to a maximum of
$5,000.00/$15,000.00 with prescription drug coverage*
*The prescription drug coverage has a $100.00 per person and $300.00 per
family deductible. After the deductible is satisfied, prescription drugs
are reimbursed at 50 percent of the allowed charge for the remainder of the
benefit period. You will need to show your card at the pharmacy to obtain
any discount that may be available and then submit your prescription claims
to Blue Cross and Blue Shield of Kansas.
The deductible starts over at the beginning of the next benefit period.

$1,000.00/$3,000.00 deductible, 50/50 coinsurance to a maximum of
$5,000.00/$15,000.00 with NO prescription drug coverage.

After the deductible is satisfied, Blue Cross and Blue Shield of Kansas
will begin reimbursing at the 50 percent coinsurance percentage of allowed
charges for covered services until your coinsurance maximum has been
reached.

There is a $25.00 copay applied to each home and office visit up to a
maximum of 5 visits per person or 15 visits per family (of 3 or more) per
benefit period. Outpatient lab and radiology services are eligible at 100
percent of the allowable up to a maximum of $300.00 per person or $900.00
per family per benefit period. After the maximum, these services are
subject to the deductible and coinsurance amounts.

An insured using a Non-Blue Choice Institutional or Professional Provider
or a Non-Blue Plan Preferred Provider will be required to pay 20 percent of
otherwise allowable amounts accumulated up to $2,000.00 per person and
$4,000.00 per family per benefit period. Deductible and coinsurance amounts
apply in addition to this 20 percent penalty amount.

The premium amounts are as follows:

Options | Medical | Dental
----------------------------------+-------------------------+---------------------
With Prescription Drug Coverage | $102.94 | $25.57
----------------------------------+-------------------------+---------------------
Without Prescription Drug | $99.76 | $25.57
Coverage | |

_________________
Life in a cage cowering in fear isn't life at all. Let those who wish to cower, cower, let those who wish to live, live!

номер 3
This option requires the use of a Blue Choice Provider for maximum
benefits.

Preventative Care at 100 percent of allowable charges:
· Doctor visits (3 per person per year)
· Flu shots
· Immunizations up to age 72 months
· Accidental injury services (up to $500.00 per person):
· Non-preventative outpatient radiology and lab services (up to $300.00
per person)

Deductible:
$2,000.00 per person or $6,000.00 for three or more persons.

After the deductible, Blue Cross and Blue Shield of Kansas will begin
reimbursement at 50 percent of the allowable for covered services until
your 50 percent accumulates to $5,000.00 per person or $15,000.00 per
family per benefit period.

This option requires the use of a Blue Choice Provider for maximum
benefits.

Blue Choice requires prior authorization by the Company for inpatient
admissions to hospitals and medical care facilities unless the admission is
for a medical emergency, a life-threatening condition, for obstetrical care
or occurs outside of the 50 United States. An insured using a Non-Blue
Choice Institutional or Professional Provider or a Non-Blue Plan Preferred
Provider will be required to pay 20 percent of otherwise allowable amounts
accumulated up to $2,000.00 per person and $4,000.00 per family per benefit
period. Deductible and coinsurance amounts apply in addition to this 20
percent penalty amount.

Prescription Drug Coverage:
The prescription drug coverage has a $100.00 per person and $300.00 per
family deductible. After the deductible is satisfied, prescription drugs
are reimbursed at 50 percent of the allowed charge for the remainder of the
benefit period. You will need to show your card at the pharmacy to obtain
any discount that may be available and then submit your prescription claims
to Blue Cross and Blue Shield of Kansas.

The premium amounts are as follows:

Medical: $101.92:

Dental: $25.57:

_________________
Life in a cage cowering in fear isn't life at all. Let those who wish to cower, cower, let those who wish to live, live!

номер 4
There are two deductible options:

$500.00 per person/$1,000.00 per family
$1,000.00 per person/$2,000.00 per family

This is a basic benefit package, which requires the use of a Blue Choice
Provider for maximum benefits.

Hospital services included in this package are general hospitalization,
Intensive Care, room, board, and general nursing services, emergency
services, inpatient services such as radiology and lab services,
anesthesia, operating room, and inpatient drugs and medicine. Medical
services include surgery both in and out of the hospital, in-hospital
doctor services and outpatient accident coverage and ambulance services.
There are no benefits for prescription drugs. The benefits are subject to a
50 percent coinsurance that accumulates to a maximum of $1,000.00 per
person, $2,000.00 per family per benefit period..

Blue Choice requires prior authorization by the Company for inpatient
admissions to hospitals and medical care facilities unless the admission is
for a medical emergency, a life-threatening condition, for obstetrical care
or occurs outside of the 50 United States. An insured using a Non-Blue
Choice Institutional or Professional Provider or a Non-Blue Plan Preferred
Provider will be required to pay 20 percent of otherwise allowable amounts
accumulated up to $2,000.00 per person and $4,000.00 per family per benefit
period. Deductible and coinsurance amounts apply in addition to this 20
percent penalty amount.

The premium amounts are as follows:

Option | Medical | Dental
---------------------------+------------------------------+------------------------
$500/$1,000 deductible | $78.96 | $25.57
---------------------------+------------------------------+------------------------
$1,000/$2,000 deductible | $73.78 | $25.57

_________________
Life in a cage cowering in fear isn't life at all. Let those who wish to cower, cower, let those who wish to live, live!

Frequently Asked Questions about Grandfathered Status

What does it mean for a plan to be "grandfathered?" Is grandfathering
different for fully-funded and self-funded plans?
The regulation lets health plans (both fully-insured and self-insured
plans) that existed March 23, 2010, when the Patient Protection and
Affordable Care Act (PPACA) became a law, to be "grandfathered" and
thus be exempt from some of the new law's provisions. These plans can
make routine changes such as cost adjustments to keep pace with the
medical inflation, adding new benefits, making modest adjustments to
existing benefits, voluntarily adopting new consumer protections
under the law, or making changes to comply with state or other
federal laws. Premium changes are not taken into account when
determining whether or not a plan is grandfathered, or if it remains
grandfathered. Grandfathered plans are exempt from provisions of the
new law, such as coverage for recommended preventive services with no
cost-sharing and guaranteed access to OB-GYNs and pediatricians.

How does a plan lose its grandfathered status?
The rule sets firm limits on how much a plan's current coverage can
be changed before it loses its grandfathered status. Compared to its
policies in effect March 23, 2010, a grandfathered plan cannot:
significantly cut or reduce benefits; raise coinsurance percentages;
significantly raise copayment amounts; significantly raise deductible
amounts; significantly lower employer contributions; or add or
tighten an annual limit on what the plan pays.

Who will tell me whether or not my plan or coverage is grandfathered? When
will I be notified?
The new rule requires your employer or insurer to provide you notice
of your plan's grandfathering status. If you buy your own insurance,
you should ask your insurer if your plan is grandfathered.
Information on the grandfathering status of your particular plan will
be included in a letter you will receive in conjunction with your
next plan anniversary on or after Sept. 23, 2010.

What effect will the new rule have on employers who now provide their
employees with health coverage?
Many of the new benefits provided under PPACA will apply to group
health plans whether that plan is grandfathered or not. The reforms
that apply to all health plans beginning on or after Sept. 23, 2010,
include: no lifetime limits on coverage for all plans; no rescissions
of coverage except in cases of fraud or intentional misrepresentation
of material fact; and, extension of a parent's coverage to most young
adults under age 26.

Will a grandfathered plan be able to make some changes without losing its
grandfathering status?
Yes. Grandfathered plans will have the flexibility to make changes in
order to remain active so long as they don't dramatically reduce
people's benefits or increase their cost-sharing. Among other things,
plans will be able to: raise premiums to reasonably keep pace with
health care costs; make some changes in the benefits that they offer;
increase deductibles and other out-of-pocket costs within limits; and
continue to enroll new employees and new family members.


My company offers several different benefit options to our employees. Will
they be grandfathered collectively or separately?
Each benefit option in place March 23, 2010, would be reviewed
separately for its grandfathered status. Please speak with your Blue
Cross and Blue Shield of Kansas sales representative, your legal
counsel or tax advisor for additional information.

Even if my plan is grandfathered will I receive any additional benefits
under the new law?
PPACA requires all health plans - including grandfathered health
plans - to provide certain new protections for plan years beginning
on or after Sept. 23, 2010. The reforms that apply to all health
plans include: no lifetime limits on coverage for all plans; no
rescissions of coverage except in cases of fraud or intentional
misrepresentation of material fact; extension of a parent's coverage
to most young adults under age 26.

How does this policy affect fully-insured plans that are negotiated by
unions - collective bargaining agreements (CBAs)?
All fully-insured health plans subject to collective bargaining
agreements are generally able to maintain their grandfathered status
through the end of the agreement as long as the agreement was in
effect March 23, 2010. The law and regulations also include a special
rule for such collectively bargained plans that gives additional
flexibility to change insurers during the collective bargaining
agreement in effect on the date that PPACA was signed. After that,
these plans are subject to the same grandfathering rules as other
health plans.

How does this policy affect self-insured plans that are negotiated by
unions - collective bargaining agreements (CBAs)?
Self-funded CBA plans are subject to the same grandfathering rules as
any other self-funded group health plan. This means they must adopt
the required provisions of PPACA on or after Sept. 23, 2010.

Will PPACA and the new rule mean more administrative responsibilities for
employers who provide their employees with health coverage?
Employers that already provide many of the benefits and protections
provided for under PPACA will experience relatively little change. The
grandfather regulation provides illustrations to help guide employers'
decisions. When employers tell employees about their health plans,
employers who believe their health plans are grandfathered must include
information about their status and maintain records needed to verify it. In
addition, the regulation includes provisions to smooth the transition to
the new system by letting the government take into account a "good faith
effort" by employers to comply. It exempts retiree-only and "excepted
benefit plans" like dental, long-term care and Plan 65 Medicare supplement
plans.


The grandfather regulation says that the government may issue still more
rules on this subject. Will they be substantially different and tougher
than these?
The rule is "interim final" regulation with a public comment period
of 60 days. This means that while it has the effect of a final
regulation, the Departments of the Treasury, Labor and HHS, which are
issuing the rule, will examine the comments that they receive and
make necessary changes when the regulation is issued in final form.
Additional clarifications to address issues that may arise under
these regulations could also be published by the departments in an
on-going manner through administrative guidance other than in the
form of a regulation. The grandfather rule does state that any
changes that are made after it is published will only apply moving
forward.

_________________
Life in a cage cowering in fear isn't life at all. Let those who wish to cower, cower, let those who wish to live, live!

Deductible скорее всего означает 1000 на человека или 3000 на семью. Coinsurance означает что сначала ты платишь из своего кармана в виде deductible и copays, как только сумма этих выплат достигает 1000, то твоя страховка начинает покрывать последующие счета на 80%, а ты платишь 20%. Как только сумма твоих выплат 20% достигает $3000, то твоя страховка после этого начинает покрывать всё на 100%.
Пример:

Ты попала в больницу и тебе пришёл счёт на 10 000. Из этих 10 штук ты платишь в виде deductible $1000 из своего кармана. Остаётся счёт на $9000. Из этих $9000 твоя страховка начинает покрывать 80% суммы, т.е. это будет $7200, а ты из своего кармана платишь 20%, это будет $1800. Итого после операции на 10 тыс долл из твоего кармана ты заплатишь $1000+$1800=$2800.
Если же твоя страховка покрывает лишь 50% на 50% (как тебе они дают один из вариантов чуть ниже на новую страховку), то ты будешь платить больше из своего кармана.

То же самое если у тебя dedcutible and coinsurance минимумы выше (как в примере на 2000/6000).

Если не понятно, задавай вопросы. Тебе нужно математически просчитать что тебе будет более выгодно исходя из того как часто и как серьёзно вы ходите/попадаете в больницы.

_________________
A woman in Russia has a chance to be almost everything except a woman

Тут сама видишь, deductible и coisurance выше. Но месячные платы ниже (сейчас ты платишь $150, а будешь $112).

Возьмём опять ту же ситуацию. Пришёл счёт за больничку на $10 000. Ты сначала платишь deductible из своего кармана $2000. Остаётся счёт на $8000. Из этих $8000 твоя страховка платит 80% суммы, а это $6400 и ты платишь 20% суммы из своего кармана, и это будет $1600. Итого ты платишь из своего кармана $2000+$1600=$3600.

Экономия по месячным выплатам: $150-$112=$38х12 месяцев=$456 долларов экономии в год. Стоят ли они того тебе нужно самой решить.

_________________
A woman in Russia has a chance to be almost everything except a woman

Здесь опять же месячные платы ниже, вместо $150 что ты платишь сейчас будешь платить $102. Экономии за год будет $576.


Возьмём опять ту же ситуацию. Пришёл счёт за больницу на $10 000. Ты сначала платишь deductible из своего кармана $1000. Остаётся счёт на $9000. Из этих $9000 твоя страховка платит 50% суммы, а это $4500 и ты платишь 50% суммы из своего кармана, и это будет $4500. Итого ты платишь из своего кармана $1000+$4500=$5500 Плюс 100% твоя страховка будет покрывать только когда сумма твоих выплат из твоего кармана достигнет $5000 в год (это после deductible).

_________________
A woman in Russia has a chance to be almost everything except a woman

Но самое главное!!!





Короче говоря, твой план сейчас, как я поняла grandfathered, значит они не имеют права сильно поднимать premiums, deductibles, copayment amounts и т.п. Как только ты изменишь план, то он станет у тебя nongrandfathered, т.е. они если захотят, смогут сильно поднять ценовые диапазоны на план.


Я не знаю какай у вас там ситуация, но я бы если была бы на твоём месте ничего не меняла бы при таком раскладе.

Насколько тебе подняли месячные выплаты?

_________________
A woman in Russia has a chance to be almost everything except a woman

я самом начале - 2009 год - платили точно помню меньше 100, вроде как 70-80. ПОтом добавили дентал, но он только 25 в мес, потом они повышали, повышали, и вот теперь почти 150. мы эплаимся на медикейд для ребенка сейчас, но я не знаю, дадут ли. Возможно что нет.

А вот такой вопрос - пока мы ходим первые 5 визитов в год, мы за них пдатим только копэй 25. Т.е вначале у тебя 5 визитов, которые они полностью покрывают, потом уже идет дидактибл - я верно ли понимаю, что в это время мы оплачиваем офисные визиты полностью 100%?, потом платишь 20% пока не выплатишь коиншуранс? верный ход моих мыслей? или почему в первые 5 визитов мы не платим ничего кроме 25 копея?

_________________
Life in a cage cowering in fear isn't life at all. Let those who wish to cower, cower, let those who wish to live, live!

а вот что прислали с ehealthinsurance.com - 3 плана. Форматирование исчезает, должно быть в табличке.

это НА МЕНЯ И НА РЕБЕНКА. НУ и дедактиблы там...
Insurance Plan Summary
Company
Plan Name KIGO11C1000150 50 KIGO11C75090 50 KIGO11C50065 40
Estimated Cost $103.75 monthly $113.75 monthly $125.57 monthly
Plan Type PPO PPO PPO
Deductible Family: $ 20,000 Family:$15,000 Family:$10,000
$ 10000 Ind/ $20000 Fam $7500 Ind/ $15000 Fam 5000 Individual/ 10000 Family

Coinsurance 20% after deductible 20% after deductible 20% after deductible

Out-of-Pocket Limit Family:$30,000 Family:$18,000 Family:$13,000
Does not include deductible Does not include deductible Does not include deductible

Office Visit for Primary Doctor $ 50 Copay $50 Copay $40 Copay

Office Visit for Specialist $100 Copay $100 Copay $80 Copay

Lifetime Maximum Unlimited Unlimited Unlimited

Health Savings Account (HSA) Eligible No No No

Out-of-Network Coverage Yes Yes Yes

_________________
Life in a cage cowering in fear isn't life at all. Let those who wish to cower, cower, let those who wish to live, live!

по врачам мы не ходим, в больницы не попадаем, ведем здоровый образ жизни Веростность конечно есть - а оан всегда есть, как с рассеченным подбородком, но не очень большая.
Ходили вот к хиропрактику как раз 4 раза с ноября - страховка покрывает, а к обычным - стараемся не ходить.

_________________
Life in a cage cowering in fear isn't life at all. Let those who wish to cower, cower, let those who wish to live, live!

Алтея, ВСЕ страховки повышают цены практически каждый месяц. Вне зависимости от покрытия. Особенно елси вы ходите по врачам. Такова их сучность. А сейчас, после изменений в законе они тем более ищут способы вернуть потерянные деньги.

Пока Медикейд не дадут вам, не отказывайтесь от платного покрытия.


Да, платите copay (который обычно НЕ включают в deductible). На 6 визит с вас возьмут по полной программе. Ну, скажем, возьмут $200 за приём. И тогда включается ваш deductible. Эти $200 вы будете платить из своего deductible (который у тебя $1000), будете платить пока штуку баксов за последующие визиты не выплатите сами. Только потом страховка начинает покрывать вас на 80%.

В первые 5 визитов вы не платите ничего кроме $25, так как у вас согласно плану первые 5 визитов только на $25 и выходят. Однако это только визит, все дополнительные тесты в лаборатории, УЗи и прочие дополнительные услуги обычно платятся отдельно.

_________________
A woman in Russia has a chance to be almost everything except a woman

Марин, большое тебе человеческое спасибо - ухватила суть сразу. Я бы ковырялась 3 дня с их текстом

_________________
Life in a cage cowering in fear isn't life at all. Let those who wish to cower, cower, let those who wish to live, live!