Insurance and their demands

[gonecamping]

So my Dh's contract just settled so we now know what kind of hit his paycheck is going to take for the next two years. He is a state employee so its been kind of touch and go with our governor wanting to do major cutbacks in salary and benefits. I know he is lucky to have a job. We have always had fully paid insurance which was a major perk when my dh took this job 7 years ago. He also took a huge hit in wages when he quit his private sector job to take this one. It was the benefits of working for the state that lured him. Finally after 6 years, his wages were what they were at his previous job. We have been anticipating having to pay for some of our insurance. Today, we found out what our premium is going to be, that coupled with the furlough days equals about 8% reduction in his monthly pay. That is manageable, like I said we are lucky he has a job. Then we get notice from the insurance company. We will have to go to the doctor, be weighed and measured and if we aren't at a certain weight for our height, we will have to pay a surcharge and attend a mandatory weight loss program. Same with smokers, if you smoke (which we don't) you have to pay surcharge and attend a quit smoking program. I can't tell from the material we got if there is a choice or not. Also, since I have insurance available to me through my job, we will pay a $50 surcharge a month. I opt out of my insurance because its $400 a month for it and we don't really need to be double covered.

I already struggle with my weight, and am on weight watchers. DH is a little overweight but according to the insurance company scale, he is out side of their "limit". I find this to be very intrusive. My first thought was "Are you kidding me???"

How dare they tell me that I HAVE to lose weight or pay more money. I realize that obesity is a problem in this country, and the obese have more health problems as well as smokers. But to demand that we fit their parameters or pay more money just ticks me off. And BTW their parameters for women is a waist measurement of 36 and men 38. Anything over that is the surcharge and weight loss program. Mine is 38 and dh is 40.

I supposed I shouldn't complain because lots of people don't even have insurance but I am a little crabby right now.

[sherry]

I feel your pain. My hubby lost his job about 2 years ago, then he was picked up as a contractor at another shop, and about3 months ago they hired him as a perm employee- we are so glad. But, it is a small place and they do not offer group health insurance. We currently pay 2100.00 a month to cover me, him & our daughter. It is outrageous but I dare not go without health insurance. But they also used a weight table for all 3 of us. I'd gladly pay 100% of a group health insurance premium if his company would just get one, as it would definitely be cheaper than what we are paying. Good luck to you!

[TraciL]

i understand your frustration and have gone through it as well.

I just would like to point out that it's not the insurance company - but the employer that makes those decisions and determines what provisions they want to subject their employees to. When the employer designs their plan 1 of the first ways to cut the cost is to increase prescription co-pays, decrease benefits in areas such as chiropractic and mental health and implement surcharges.

I work for one of the top companies and my benefits have the same issues. If I cover my husband because he can get his own insurance it's a $50 surcharge per pay period plus the premium increase. Smokers pay a $4.00 per pay period surcharge (I don't smoke). His premium is less than the surcharge so he takes his own.

It's cheaper and puts the employer at less risk if the spouses take their own insurance. They believe they are encouraging their employees to live healthier lifestyles by implementing the surcharges.


I would check into other 'incentive' plans with the company. Usually when they run it the way you are describing they also give incentives for meeting certain goals or participating in other plans.

For example: a cash bonus or $ off next years premium if you
do a company sponsored weight loss program
get the routine exams and tests recommended for your age group
get a mammogram

An employer I'm familiar with actually gives the employees CASH every quarter for doing 'healthy' things. Like walking, and drinking water, and tobacco cessation etc. They fill out score cards and turn them in quarterly and get cash back.

I have a super high deductible because they are 'putting the cost in the hands of the consumer' meaning they want us to think twice before running to the ER for a $2,000 bill for a sore throat. So my deductible is $1800.00. Not a great plan for a diabetic!

But I did the company programs and saved $600 on this years premiums. I had to get the physicals and stuff and then because I'm diabetic my doctor had to fill in a form that basically said I"m diabetic and my blood sugar levels will never be below 110, so then I got a waiver and credit for the test. Plus all the routine tests are paid at 100% by my company.

insurance and healthcare and basically everything is a mess - that's my opinion

[blbabe1234]

Geez, what kind of @$$holes run that insurance company? That's freaking ridiculous.

[TraciL]

I feel your pain. My hubby lost his job about 2 years ago, then he was picked up as a contractor at another shop, and about3 months ago they hired him as a perm employee- we are so glad. But, it is a small place and they do not offer group health insurance. We currently pay 2100.00 a month to cover me, him & our daughter. It is outrageous but I dare not go without health insurance. But they also used a weight table for all 3 of us. I'd gladly pay 100% of a group health insurance premium if his company would just get one, as it would definitely be cheaper than what we are paying. Good luck to you!

oh my sherry! that seems really high - i'm sorry you have to pay that

[amberella]

I know some programs offer you discounts/incentives if you prove that you're exercising, going to the Y, trying to be healthy, etc., but I've never really heard of this. By the same logic, they should charge more for a LOT of things that are totally personal choices/problems. You should get charged for being in the sun (skin cancer), driving (likelihood of accidents), eating (you might choke or get food poisoning), breathing (you might have allergies or asthma), working (could catch some illness from someone at the office), etc.

If they really want, they should offer you incentives to start being healthier, and not make them REQUIREMENTS. Nor should they be universal requirements - you can lose weight but maybe not lose inches in the "right" places, and you can also NOT lose weight but lose fat and gain muscle. It's up to you and your doctor to decide if you really have a weight problem, or if you're actually healthier than some arbitrary measurement would seem to say.

[Ayla]

Traci is right....all of these plans' requirements are employer driven. They are the ones who decide what they will pay for and what they won't. I used to work for a regional HMO...highly respected one, and a good company to work for. We had over 30 different benefit plans...all because employers wanted certain options, some things covered, some things not covered. Now, working for a hospital, I have decent coverage. The basic premiums are income driven...it costs a little more if you are in certain income brackets, which I don't particularly mind. It's not outrageous for full time employees either way, and at my income level I can certainly afford a little more than someone who makes only minimum wage. At least they offer it to people who make minimum wage! I am lucky...I pay not quite $40 premium biweekly...but if there is a 3rd paycheck that month like sometimes happens, we don't pay in the third pay check. I have a $15 copay for office visits from my primary care doctor, $25 for specialists. There are no deductibles if I stay within the network, and of course coverage is less if I go outside the network unless it is an emergency. I have to use a mail order pharmacy, which I despise becuase they are inept (once they called me to tell me they couldn't fill my prescription becuase they didn't have my phone number...excuse me, how did you call me to tell me that then?). One med I am on is not considered maintenance, so it HAS to be filled locally (gee, doesn't bother me a bit), and the other is covered under one of the local pharmacies' $4 prescription program, wich si actually less than my copay for the mail order! Part timers can actually buy insurance for their whole family, and it is approximately $300-400 a month for full family coverage. Not bad! Especially when you consider that many employers don't offer insurance at all, much less to their part timers. You can also get a discount for participating in a health assessment...I think it gives you a $20 per month discount on the premiums.


My health insurance company itself will not hire smokers...and I've heard of hospitals that won't hire smokers either. But for the acctual plans, it often is not the insurance company that writes the rules...it is the employer, as THEY decide what they will pay for or not.

[gonecamping]

I feel your pain. My hubby lost his job about 2 years ago, then he was picked up as a contractor at another shop, and about3 months ago they hired him as a perm employee- we are so glad. But, it is a small place and they do not offer group health insurance. We currently pay 2100.00 a month to cover me, him & our daughter. It is outrageous but I dare not go without health insurance. But they also used a weight table for all 3 of us. I'd gladly pay 100% of a group health insurance premium if his company would just get one, as it would definitely be cheaper than what we are paying. Good luck to you!

Wow, I really shouldnt' be complaining. I am sorry you have such a huge premium. Hopefully his employer will start offering group insurance soon! Can you go elsewhere and get a better rate on your own?

[gonecamping]

Since our insurance is for state employees, its a huge pool and and entity all of its own. The board sets the policies and premiums. We are in the option that has the highest deductibles, which they just raised, along with the highest co-pays. They have lowered coverage and raised co-pays. I could go with one that has better co-pays, $5 versus 15% but that means we would have to travel 45 minutes or more one way to see a doctor and its hard to get into to see them because there are so many people on that plan. So I pay a little more in co-pays to see a doctor here in our town. I figure the gas money I am saving makes it a wash. I can't afford the insurance at my work because its $400 alone for me or for the family..no break in just insuring myself so we will have to pay the surcharge.

[scrapscot]

hmmmmm....and people are complaining because the Dems want a universal health coverage. France and the UK have good plans.

[sarahwhithers]

Yikes! That does not sound right to me! I don't blame you for being upset on that one.

I can say that the health coverage in Canada is not even close. We have medical expenses pretty much paid for. I do pay for insurance like dental and chiro and stuff, but it's a fairly small amount. I couldn't imagine not having the coverage, which is prob why I'm a Canadian for life.

So, who wants to move to Canada now? haha!!

[gonecamping]

hmmmmm....and people are complaining because the Dems want a universal health coverage. France and the UK have good plans.

For me its not about a universal health care plan, its the plan they pushed through that I don't much care for. Some parts of it anyway.

[deerewife]

I don't know that it's all employer driven. We are self insured and I pay a surcharge because I've had surgeries in the last few years on my ovaries and uterus and am therefore 'at risk' for more complications. Plus, I'm overweight and subject to more 'complications'. Plus we pay a surcharge for my dd as she has asthma and is 'at risk'.

We don't get a choice other than to turn down the insurance. And most insurance companies do this it's just that the employers will sometimes cover this extra costs and you don't see them as they are required to cover you.

Be glad that you can get insurance and it's not costing you over $1000 a month with high deductibles. We have looked into switching and it's not cost effective or my dd and I don't qualify because we are too 'high risk'.

And unless they reform lawsuits I don't believe any of this will change. But, of course that's just my opinion.

[deerewife]

hmmmmm....and people are complaining because the Dems want a universal health coverage. France and the UK have good plans.

But in these countries there is very limited unemployment and no handouts. You have to work to get the benefits. Here, we give away too much for no return.

[Ayla]

Here, we give away too much for no return.

I agree whole heartedly....I see it every day in the ER!

[TraciL]

Here, we give away too much for no return.

I agree whole heartedly....I see it every day in the ER!

AGREED

[JulesinParadise]

Our retirement insurance ends when we turn 65. I don't qualify on my own for Medicare but my husband does because of his military and his work outside of teaching. . I was about 13 units shy of qualifying but as teachers, we did not pay into social security. Currently we pay about 800.00 a month for my insurance and for his medicare supplementals. Next year, we are looking at a major increase. I don't know what people our age do that have their insurance expire at 65 and do not qualify for medicare.

High insurance rates suck royally but what choice do we have?

[TraciL]

Our retirement insurance ends when we turn 65. I don't qualify on my own for Medicare but my husband does because of his military and his work outside of teaching. . I was about 13 units shy of qualifying but as teachers, we did not pay into social security. Currently we pay about 800.00 a month for my insurance and for his medicare supplementals. Next year, we are looking at a major increase. I don't know what people our age do that have their insurance expire at 65 and do not qualify for medicare.

High insurance rates suck royally but what choice do we have?

Jules - can't you both get CHAMPUS if he was military?

[Kimandasmo]

I agree with the surcharge shit...we are starting to go through that at my job as well. It hit the smokers last year. We were told that insurance will eventually be based on weight, smoking and other risk factors along with family history. It is totally BS!

[JulesinParadise]

Our retirement insurance ends when we turn 65. I don't qualify on my own for Medicare but my husband does because of his military and his work outside of teaching. . I was about 13 units shy of qualifying but as teachers, we did not pay into social security. Currently we pay about 800.00 a month for my insurance and for his medicare supplementals. Next year, we are looking at a major increase. I don't know what people our age do that have their insurance expire at 65 and do not qualify for medicare.

High insurance rates suck royally but what choice do we have?

Jules - can't you both get CHAMPUS if he was military?

I don't think so...he was only in for four years. You may not remember the first draft the US held during the Vietnam War but my honeys draft no. was 1! He served in the Air Force for four years but then returned to teaching.