health insurance question: i work for a small company. we switched to a cheaper health insurance plan within?

Question

oxford because i added my wife and 2 kids on after my wife left her job. my current plan would have cost 1,900 a month for family coverage. we switched to one through oxford as well with 1,300 a month coverage. the in network coverage seems to be identical except the copays are 20 for primary care and 30 for specialist instead of 10 and 10 on the old plan. in network hospitalization is 500 dollar co-pay for in-patient and $250 co-pay for out-patient.

on the out of network this is the deal: 2,000 deductible per person and 6,000 per family total deductible. co-insurance is listed as 70% of 10,000. out of pocket is listed as 3,000 per person and 9,000 per family excluding deductible. out of network hospitalization is deductible and co-insurance. out of network E.R. visits are 75 dollars each.

my general question is this decent health insurance? would this be considered high deductible insurance? would i be completely screwed if a family member had to stay out of network at a hospital?

for example, if we are on vacation and someone needed major hospitalization and there was no oxford network hospital. we could take a hit.

heres the deal if we take the 1,300 a month insurance my work covers the whole thing. if we took the 1,900 a month insurance i would have to pay the 600 dollar difference myself (difference between 1,900 and 1,300). did i do the right thing by picking the 1,300 dollar one so i dont have to pay anything out monthly and it is completely covered by work?

Answer 1

This is decent health coverage. Most plans will cover out of network benefits at the same level as in network if you have an emergency and need immediate care. But, you are expected to transfer to an in network facility as soon as you are stable and can do so. You might want to consider getting you wife and/or kids an individual plan instead of using your employer group plan. It may save you some money that can help offset your higher out of pocket costs.

Answer 2

Most insurance companies I deal with will automatically pay out of area ER and Urgent care visits at your in network benefit level... They realize you can't control an emergency away from home.
Honestly, there should be no need for you to seek are at a non-network hospital, unless you want to see a specific doctor, or whatever. Oxford is not a bad plan to have, so I've heard... And, the more expensive plan you described seems to only allow additional freedom; not necessarily better or more healthcare. If it were me, I'd stick with the less expensive oxford plan... The in network copays are reasonable, compared to a lot of plans. As long as you're ok with seeing their doctors, it shouldn't be a problem.

No, this is not 'high deductible' insurance. Its a basic Point of Service plan. (which is sort of like an HMO, with out of network benefit options. Or a very weird PPO)

Just call Oxford, and ask how they handle their claims if you have an emergency hospital admission out of area... And, how they handle ER/Urgent Care in general... I'd bet they pay them in network, no matter what....

Answer 3

This plan does not qualify as a High Deductible Health Plan.

It looks to me that you made a good move on this one. There are some minor increases in copays, but the monthly savings far outways these increases.

As far as out-of-network hospitals, this would not apply if you were traveling and someone had to be hospitalized. You will be covered. If it is a bona-fide emergency, seek medical attention at the nearest emergency room. You will have to contact Oxford within 24 hours to report the visit. If it is an urgent matter, that cannot wait until you return home, contact Oxford at the number on the back of the card and ask them to refer you to a local doctor or urgent care center. This will typically be treated as an in-network visit. One advantage to being an Oxford client is that, as they are now owned by United HealthCare, you have access to the United network of doctors and hospitals outside of your home state. Their network extends through many areas of the United States.

Basically, the key to care outside of your home state is communication.

Answer 4

A healthy family of four who can afford that much really needs to look at a Health Savings Account and start saving money. You can insure your whole family for 100% after you cover one deductible. Put your monthly savings into an IRA type of account that earns 5%. This is pretax money. You get a debit card to pay for any medical services AND supplies (aspirin,bandaids etc) The whole theory is 'if you don't use it you don't lose it' and it will be another retirement fund.

Answer 5

Considering, this is about average health insurance.

If you're out of your local area - for instance, if you live in New York and are in North Carolina on vacation, it is very unlikely that you will find an in-network provider there - especially with Oxford, because their network is pretty much NY,NJ, & CT. But there's ways around just about everything. Calling the member services number on your card and asking them for direction to a provider is your best bet - because if they can't find anyone in network, they HAVE to authorize out of network, (get the name of the person!!) and they might be able to convince the out of network provider to accept in-network payment. (It can happen!) If youlre in your local area, it'll be harder to get out of network paid this way, unless the hospital or doctor does something special that NO ONE in network does.

Basically, the reasoning behind the high out of network expense is because insurance companies want you to use participating providers whenever possible. They also STRONGLY encourage each person to utilize a PCP (Primary Care Physican) as much as possible to coordinate their care. (If a member of your family is hospitalized, be sure you notifiy their PCP on the next business day so they can note the chart and be helpful in case you need to fight something. Some plans try to weasel out of paying if they don't think you contacted your PCP.)

Pretty much, as long as you follow the general rules to the best of your ability, you can get most insurance plans to play ball.

Answer 6

You might try this website I have used:

www.healthinsurance-guide.net