Medical Insurance Question?

Discussion in 'After Hours Lounge (Off Topic)' started by Johnny Angell, Mar 1, 2006.

  1. Johnny Angell

    Johnny Angell Played With Dinosaurs Member

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    My wife was recently notified she is being laid off. Unless she finds another job soon, she will lose her medical benefits. I know we can keep them a while thru Cobra (paying full fair, of course),but eventually they will be gone.

    Back on 2001, when I was laid off, I qualified for "retirement" with my company. Basically all I got out of that was I could buy medical insurance through the company, paying full fair, which we elected to do. Since my wife was employed we elected to get her insurance through her employer.

    I was told at the time that I could add my wife to my retiree insurance at a later date via a qualifying event and losing her job was a qualifying event. NOT.

    We've now been informed that the only way to put her on my retiree insurance was to do it then at the time I was laid off. I cannot add her now. A qualifying event now would be if I just married her yesterday, then I could add her.

    The question is this: since we would be paying 100% of the premium for the insurance, why this restriction? We have always kept ourselves insured for our entire working lives. We our seeking to do that by paying the full premium. What skin off their noses is this that they should care?

    I guess its a little less admin work for them.
     
  2. ChrisMatson

    ChrisMatson Cinematographer

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    My guess is that you don't pay the full cost of an individual plan now.

    More likely, you are probably paying the full cost for an individual in a group plan. Group plans through employers (or in my case, through a university) offer some savings over buying an individual plan, but are by no means cheap.

    If you were paying the true full price for an individual plan and are not happy with your company's service, why not take your money elsewhere? Perhaps you and your wife could find another plan that suits your needs and would even be more cost effective for you.

    Shop around.

    Perhaps one day, this will be a moot point. The United States is the only "modern" country that does not provide medical care to its citizens.
     
  3. Johnny Angell

    Johnny Angell Played With Dinosaurs Member

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    Yes, that is true. It's a group plan, and as such, I presume less expensive than an individual plan.

    What I don't understand is that it won't cost my former employer $$ to add my wife, unless its an administrative expense. We pay the entire premium, so why the restriction?

    There may be a good reason for it, just would like to know it.
     
  4. Mort Corey

    Mort Corey Supporting Actor

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    I would guess that the company has some form of written guidelines (like an employer/employee handbook). To deviate from their own written rules could open up a can of worms.....ie some type of discrimination lawsuit.

    On the other side of your question of "why won't they", is "why should they"?

    There are a ton of individual plans available so it would be worth exploring those through a professional agent that specializes in that field. It won't cost you anything to shop around.

    Good luck

    Mort
     
  5. Bryan X

    Bryan X Producer

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    Yes, it could possibly cost the employer a lot of money.

    The company could be 'self insured'. That means that the employees pay the premium, which the company keeps. Then the company pays for the covered medical expenses.

    If this is the case, yes you pay 100% of the premium, but the company would still have the expense of paying for your medical expenses out of it's pocket. If your medical expenses exceeded your premium payments, it costs the company money.

    Generally, if a company is self insured, they will have 'stop loss' insurance. But that just means that the company is only liable for your medical costs up to a certain threshold, say $50,000 or $100,000. After that the 'stop loss' insurance kicks in to prevent the company from paying out even higher expenses for an individual.
     
  6. Johnny Angell

    Johnny Angell Played With Dinosaurs Member

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    Isn't the idea behind insurance, shared risk? If the company is self-insured, don't all medical expenses come out of the pool of premiums. It doesn't seem accurate to say that if our medical expenses exceed our premiums, that we are costing the company money. Wouldn't it still be coming out of the pool of premiums paid in?

    Doesn't insurance only work when you have enough people paying in premiums that don't have medical expenses to pay for those who do have medical expenses?

    BTW, no one has to persuade us to look into other avenues of insurance, we know we need to. I was just trying to understand what is going on. If I gave the impression I was trying to fight the situation, sorry.
     
  7. Bryan X

    Bryan X Producer

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    Yes, the expenses come out of the entire pool of premiums. But in all likelyhood, the medical expenses far exceed what the employees are paying in premiums.



    If you are talking a large insurer, probably. But a self-insured company probably doesn't have a large enough or diverse enough employee base to come out ahead.

    But some companies still do this because it can be cheaper than having a third party insurer.
     
  8. Dennis Nicholls

    Dennis Nicholls Lead Actor

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    Johnny,

    You need to learn about HIPAA (health insurance portability and accessability act). It takes over when COBRA (consolidated omni-bus reconciliation act) runs out at 18 months. Go Google HIPAA and see how it applies to you. It's the closest that the Clintons got to getting national health care.
     

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