The two seasons a year I hate the most are Tax Season, and Open Enrollment for our Health Insurance Plan. The later is interesting as it gives me a fabulous lens from which to see and feel a clients frustration as they wade into the perceived toxic waters
of buying insurance. Even with my background, I become exasperated, confused, frustrated and ultimately passively resigned to the realities of the health insurance marketplace. When I am done reviewing the Health Insurance for the company, and my family I
always come away with, "this must be how my clients feel", which ultimately led me to form Metropolitan Risk; the founding basis
MAKING INSURANCE PAINFREE TO PURCHASE THRU PROTOCOL. Simply translated it’s an ongoing process to teach employees , and senior management how to manage their companies risk, understand how insurance fits into the whole process,
thereby making it much easier to manage and buy because we understand it, and are comfortable because we can manage the end result ( the price we pay) which can be very cathartic.
I am off my soap box and onto the meat of why you clicked here in the first place. First the bad news; Health Insurance premiums are set to rise 8.8 % according to benefit consulting firms. If you are an employee, the effective increase will be higher 12.5%
once you take into account , deductible increases, premium increases , higher co pays, and co-insurance. It’s that special!
What Can We Do Insurance Mic? Glad you asked , let’s break it down on the telestrater.
OUT OF POCKET EXPENSES:
I love spreadsheets! They are my Magic 8 Ball, lets see what they say. To do a fair comparison we need to see what you spent last year. Create a Column on you spreadsheet that’s labeled "LAST YEAR" , in the row description put in items such as "insurance
premium" "deductibles" "prescriptions", "co-pays" or "co-insurance" which ever was applicable. Label the second column "Current Year" . Input into this column the answers the descriptions I stated above to see what the cost difference will be to your family
in this current year contingent on which Health Insurance Quote or Option you choose. Try and keep you inputs consistent with the previous year so your data, and answer has integrity. For example if your family paid a $50 co-pay last year per visit, and they
visited the doctors office 10 times. The answer for that Row is $500 . If the current year the Co-Pay goes up to $75 per visit , use 10 visits as your benchmark for the current year and input the cost for this line items as $750. See where Waldo is going here.
Do this for each row description to compare the new proposed plan, versus what you had last year to figure out what proposal has the least cost associated with it, not necessarily the lowest cost premium. It’s all about the out of pocket expense, NOT the
premium Jimmy Neutron!
COVERAGE FOR DEPENDENTS:
Insurance carriers have been chisiling coverage away little by little for years, 2011 will be no exception and may even be worse. Experts suggest that premiu charges for dependents should increase for dependents on your health plan. Employers may also re-structure
the way you pay for dependent coverage. Instead of charging one price for Family coverage , they are starting to charge per dependent. As an example last year a carrier may have charged $3,000 for a family plan, now they will charge $2,000 per dependent which
is an enormous increase for families! Another trend we are seeing is Employers cutting back on how much they will pay for dependent benefit packages.
IF you and your spouse work for different companies and both have access to dependent health benefits compare and contrast the coverage and premiums offered by both employers as the coverage offerings and pricing may differ substantially between the two
leaving your family an obvious choice.
CO-PAYS V.S. CO-INSURANCE :
Another sneaky trick employed by the carriers is the old Co-Insurance Trick. Simply put Co-Insurance substantially increases your out of pocket expense. Consider the following claim. You have an MRI on your knee done that costs $2,500. Your old plan has
a $50 co-pay assuming you remain in Network, your new plan has a 10% Co-Insurance
provision which means your $2,500 MRI costs you $250 out of pocket now, versus the $50 you would have spent on the
Co-Pay of your old plan. You don’t need to work for Google to figure out the math here, and who it favors.
These are just the obvious items that I thought folks should look out for. Naturally there are a slew of others contingent on you families or companies unique circumstances. We always advocate having a strong benefits consultant t help both your company,
and your employees make value decisions . One of the top reasons families file for personal bankruptcy is for Medical Costs. Please make thoughtful decisions.