Money Matters
als1982
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Our tech team has launched updates to The Nest today. As a result of these updates, members of the Nest Community will need to change their password in order to continue participating in the community. In addition, The Nest community member's avatars will be replaced with generic default avatars. If you wish to revert to your original avatar, you will need to re-upload it via The Nest.
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Help me understand my health insurance.
So, we're going to start TTC next cycle, and the month just so happens to coincide with our annual enrollment at work. I've always been fairly healthy, so while I feel VERY fortunate to have good health insurance options and blessed to not have to use it, I've never really paid much attention to it.
This year, I'm planning on buying the premium policy, which offers the below coverage:
$1,400 in-network deductible
$2,800 out-of-network deductible
10% for in-network co-insurance
40% for out-of-network co-insurance
$2,000 in-network out of pocket max (me)
Additionally, I have a total of $2,370.34 in a Health Reimbursement Account (we get dollars every year for various activities, and I've never really had to tap into this significantly).
Am I crazy to think that because of the HRA, that I won't have to pay any out of pocket?
Also, how does insurance for baby work after it's born?
HeartlandHustle | Personal Finance and Betterment Blog
Re: Help me understand my health insurance.
MW chose the 90% coverage and paid the higher premiums for our daughter. We still ended up maxing out her out of pocket which was roughly $3500 as a family.
Next is to see who should have the child on their insurance. Currently we have our children on MW's insurance. Based on the medicine for allergies that my son has, we might want to move the children to my policy next year.
As soon as the baby's born the hospital will bill services to "Baby YourLastName" and then once your baby is officially enrolled it will show his/her name. Baby will have his/her own deductible and OOP max.
We have a family coverage so we each have a $300 deductible or $600 family deductible. So if I reach $300, my husband $100, my oldest child $200, and then my youngest has his first charge for the year, he has no deductible because we met our family deductible.
Same for our OOP max.
HI can be changed during open enrollment (what you are doing now) AND/OR at what they call, significant events. Adding a child, whether biological or adopted, is considered a significant event.
So...at the time of birth you simply call the HI company and give then the baby's name and date of birth. Coverage would begin immediately for that child (pretty sure of this but you should verify on your own).
And, at least under our policy - you should check on yours - each child is covered for well-child doctor visits. We pay $0 for them to get annual check-ups and vaccines.
I would also lean toward the more expensive policy with more coverage. Especially for out-of-network. You don't know what might happen while you are in the hospital. I've heard horror stories of women choosing an "in-network hospital" and an "in-network" ob/gyn...only to have the anesthesiologist (sp?) in a C-section turn out to be out-of-network. Or, for a natural birth, the doctor that administers the epidural is out-of-network. Crazy, annoying stuff like that happens all the time in hospitals, unfortunately.
Also, don't be so quick to take an attitude of "oh, the HSA will pay for it" by taking the less expensive plan. That HSA is still YOUR money for unreimbursed medical expenses that will roll over and roll over until the day you die (hopefully many, many decades in the future). And even then, that money converts into your estate. It doesn't expire and it is never lost. Of course, you will want to use some of it now while you have more significant out of pocket costs, but don't waste it if you don't have to. I also think you can use it for unreimbursed medical expenses for your husband and underage children, ie new baby, but I'm not 100% on that.
And yes, either you or your husband can immediately add your baby to your respective work's group health plan(s). You have 30 days to do that from the day the child is born and I'm pretty sure you can retroactively set the date to their date of birth (not 100% on that).
It sounds like, as long as you don't get stuck with anything out-of-network, the most you will need to pay out-of-pocket for yourself is $2,000. Which you can use your HSA for. But your baby will have his/her own $2,000 out-of-pocket max. to hit, as well. Sounds like from the other PPs that some of those hospital costs will be billed to the baby. Lame! But I guess that is how it is done.
If you still have questions, I'd contact your insurance carrier and/or your HR Dept.
Our insurance company said this does happen and they don't always catch it. They handled this very well and encouraged us to call if we questioned any bills.
We also had this happen when H needed stitches in the ER. Hospital was in-network but ER MD wasn't. Called insurance. Easy fix. I wonder if people don't contact their insurance company and just pay the bill?
Oh, that's good to know! I think a lot of the time people don't contact their insurance and just pay the bill.
I had a former co-worker who is just one of those meticulously detailed people. After she had her baby, she looked at her line-itemed hospital bill with a fine tooth comb and found a litany of errors. Although she did eventually get things sorted out, it unfortunately took her many hours of arguing back and forth with both her hospital and the insurance.
Oh! I'm so sorry if I misread that! I'm familiar with HSA accounts and assumed that is what you were talking about. I'm also familiar with "Cafeteria Plans", which are "use it or lose it" unreimbursed medical expenses for the calendar year. Those plans have federal guidelines and rules that all companies who offer these programs have to follow.
It sounds like your HRA plan might be something that is company specific? I'd talk to your HR department about how it works. Especially to find out if it could be used for out-of-pocket costs for your baby also.
Something interesting about Cafeteria Plans (that I mentioned above) for anyone who has one. If, for example, a person chooses $1,000/year to come out of their paychecks for a Cafeteria Plan. They are allowed to use that entire $1,000 at any time during the calendar year, even if they have not paid that much into it yet.
If they leave their job for any reason (laid off, fired, quit) and some/all of the money isn't paid back, they actually don't have to pay it back. I pleasantly ran into that scenario a number of years ago. I had outspent my Cafeteria Plan by $750 at the time I was laid off. I was super worried about it and then found out...nope...doesn't need to be paid back ever. It was just a loss for my employer. But they were a big company and had laid me off, so I wasn't exactly too bummed for them.