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Ok, help me figure out our health insurance.

This is what we have:

Fund Contribution
Employer Contribution Amount
$1,125.00
Rollover Amount
$165.00
Total Starting Fund Amount
$1,290.00
Used
$0.00
Remainder
$1,290.00
Plan Information
Plan Features
Limit
Applied
Remainder
In Network, Tier 2 Annual Deductible Includes Pharmacy
$ 1,875.00
$ 0.00
$ 1,875.00
In Network, Tier 3 Annual Deductible Includes Pharmacy
$ 1,875.00
$ 0.00
$ 1,875.00
Out of Network Annual Deductible Includes Pharmacy
$ 1,875.00
$ 0.00
$ 1,875.00
 
 
 
 
In Network, Tier 2 Annual Coinsurance Includes Pharmacy
$ 1,250.00
$ 0.00
$ 1,250.00
In Network, Tier 3 Annual Coinsurance Includes Pharmacy
$ 1,250.00
$ 0.00
$ 1,250.00
Out of Network Annual Coinsurance Includes Pharmacy
$ 2,750.00
$ 0.00
$ 2,750.00

 

 

 

Does this mean we have to pay the money under limit before our insurance pays anything? I'm so stupid with insurance, because we haven't had it for so long. TIA!

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Re: Ok, help me figure out our health insurance.

  • Does this mean we have to pay the money under limit before our insurance pays anything?

    Yes, I think that it what it means. Don't quote me on that though. 


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  • If you have a deductible, that means whatever the deductible limit is in $$$, you're responsible for that first before insurance kicks in.  It's hardfor me to tell from the little clip you posted.  Is there anything in there about whether the deductible is per occurence or if it's annual?

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  • Is there a website with your company's (I'm assuming your H's) specific plan?  Is it a major health insurance carrier like CIGNA, BlueCross BlueShield, etc?

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  • We have Aetna. I *think* it's annual....
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  • Also, there is a line where his employer contributed...so do we subtract the amount they paid from the total deductible? Because if so, that leaves about $500 and some change, so is THAT the amount we pay before insurance kicks in? And I haven't seen anything about a copay, so does that mean we pay the deductible and then everything is covered 100%?

    I feel so stupid that I can't figure this out.

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  • Usually how it works isthe employer contributes an annual amount, and then you contribute an annual amount (deducted from each paycheck throughout the year).  Sometimes a deductible is involved depending on the employer and the plans they offer to their employees.

    For example, I have CIGNA and have chosen the Tier 2 Plan.  I chose it because for me that plan is a bitmore expensive (i.e. more is takenoutof my paycheck), but I have no deductible and my network of physcians is large and I don't need referrals. Also, I only have a $10 copay for prescriptions and a $20 copay for my PCP.  Typically, the less the plan willcost you out of your paycheck, the more potential there is for out-of-pockegt costs at the time any kind of healthcare service is needed.  If I had chosen to go with a cheaper plan (less $$$ takenout of my paycheck), I would have a deductible to consider whereas with the plan I'm on there is no deductible.

    Did your employer give you any kind of rate sheet that compares each planas far as how much wouldcome out of your paycheck, then show any copays and deductibles?  If not, I would contact your Benefits/HR Dept.  And a lot of times the employee handbook will also include what healthcare plans are offered and will show a rate sheet so you can compare.


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    Vacation

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  • It's hard to read this chart since it doesn't line up nicely. Can you email it to me and I can help you with it.
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