Self Insurance Win

[glockmail]

My wife's company finally took my advice and went self-insured for their employee medical plan. After a decade of the premium going up between 7 and 10% while co-pays increase and benefits decrease. They went with a managed system, which means that an insurance company administers the payouts and negotiates costs with providers. Based on past history, this plan will save them about 20% from last year and if everyone stays healthy, they'll save even more. Under the worst case scenario they could pay about 20% more. Here's a summary of the deal:

1. $10,000 deductible per family. After the deductible, no co-pays.
2. All wellness visits paid 100%.
3. First $1000 medical expenses covered 100%.
3. Between $1000 up to the deductible, company pays 60%, employee 40%.

This gives a financial incentive for folks to get healthy and stay that way.

Due to co-pays in the past, one family last year paid out over $12k in medical expenses. Under this plan they would pay $3600.

[Kathianne]

My wife's company finally took my advice and went self-insured for their employee medical plan. After a decade of the premium going up between 7 and 10% while co-pays increase and benefits decrease. They went with a managed system, which means that an insurance company administers the payouts and negotiates costs with providers. Based on past history, this plan will save them about 20% from last year and if everyone stays healthy, they'll save even more. Under the worst case scenario they could pay about 20% more. Here's a summary of the deal:

1. $10,000 deductible per family. After the deductible, no co-pays.
2. All wellness visits paid 100%.
3. First $1000 medical expenses covered 100%.
3. Between $1000 up to the deductible, company pays 60%, employee 40%.

This gives a financial incentive for folks to get healthy and stay that way.

Due to co-pays in the past, one family last year paid out over $12k in medical expenses. Under this plan they would pay $3600.

That is closer to what health care reform SHOULD have looked like. I still like my plan for routine costs to be picked up by individuals, along with 'stitches, mammograms, simple breaks...' Physicians tell people up front the costs, then make payment arrangements.

Major medical through employer or private insurer.

[aboutime]

My wife's company finally took my advice and went self-insured for their employee medical plan. After a decade of the premium going up between 7 and 10% while co-pays increase and benefits decrease. They went with a managed system, which means that an insurance company administers the payouts and negotiates costs with providers. Based on past history, this plan will save them about 20% from last year and if everyone stays healthy, they'll save even more. Under the worst case scenario they could pay about 20% more. Here's a summary of the deal:

1. $10,000 deductible per family. After the deductible, no co-pays.
2. All wellness visits paid 100%.
3. First $1000 medical expenses covered 100%.
3. Between $1000 up to the deductible, company pays 60%, employee 40%.

This gives a financial incentive for folks to get healthy and stay that way.

Due to co-pays in the past, one family last year paid out over $12k in medical expenses. Under this plan they would pay $3600.


Glock. If only we could somehow convince the Obama admin, Democrats in Congress, and the Under, and Un-educated Americans who voted for Obama how great such a system would be...Far and Above any OBAMACARE promises that WILL cause more headaches than anyone could handle.
Problem is, and always will be.....The Lack of Education, Financially, and Economically. But the training needs to start with Obama and Congress for it to go anywhere.

P.S. Hey Glock. Have you considered running for an Office where REAL people, with REAL minds could get together to come up with REAL Solutions?

[glockmail]

Glock. If only we could somehow convince the Obama admin, Democrats in Congress, and the Under, and Un-educated Americans who voted for Obama how great such a system would be...Far and Above any OBAMACARE promises that WILL cause more headaches than anyone could handle.
Problem is, and always will be.....The Lack of Education, Financially, and Economically. But the training needs to start with Obama and Congress for it to go anywhere.

P.S. Hey Glock. Have you considered running for an Office where REAL people, with REAL minds could get together to come up with REAL Solutions?

You'll never convince elected Democrats because its not about health care or value but about power and control. This simple fact explains everything that they do. Obamites think that their savior will have everything paid for and free and don't want the responsibility to take care of themselves because they are stupid and lazy.

I held two low ranking party offices in a previous life for the Conservative Party of New York, representing a whopping 1% of the electorate. Guys like me don't do well in the GOP since we tell the truth and most people can't handle the truth

[glockmail]

That is closer to what health care reform SHOULD have looked like. I still like my plan for routine costs to be picked up by individuals, along with 'stitches, mammograms, simple breaks...' Physicians tell people up front the costs, then make payment arrangements.

Major medical through employer or private insurer.

All that GovCo needs to do is get out of the way of private insurers. Regulation is important and contracts need to be enforced but there needs to be as much flexibility as possible to let the market work.

If Comapny A wants to pay the first $1000 and wellness then so be it, and if Company B does not that's fine too. Both need to finds ways to attract and retain their employees. Company B would have to compete with Company A by increasing wages or some other benefit.

[aboutime]

You'll never convince elected Democrats because its not about health care or value but about power and control. This simple fact explains everything that they do. Obamites think that their savior will have everything paid for and free and don't want the responsibility to take care of themselves because they are stupid and lazy.

I held two low ranking party offices in a previous life for the Conservative Party of New York, representing a whopping 1% of the electorate. Guys like me don't do well in the GOP since we tell the truth and most people can't handle the truth


Previous Life? How bout this one? I agree with you 100%. Once you start introducing Honesty, and Truth into the Political Realm of Reality. The biggest enemies you'll ever have are those TOO STUPID, DUMB, and IGNORANT to not only handle it....but KNOW WHAT IT IS?

[Mr. P]

My wife's company finally took my advice and went self-insured for their employee medical plan. After a decade of the premium going up between 7 and 10% while co-pays increase and benefits decrease. They went with a managed system, which means that an insurance company administers the payouts and negotiates costs with providers. Based on past history, this plan will save them about 20% from last year and if everyone stays healthy, they'll save even more. Under the worst case scenario they could pay about 20% more. Here's a summary of the deal:

1. $10,000 deductible per family. After the deductible, no co-pays.
2. All wellness visits paid 100%.
3. First $1000 medical expenses covered 100%.
3. Between $1000 up to the deductible, company pays 60%, employee 40%.

This gives a financial incentive for folks to get healthy and stay that way.

Due to co-pays in the past, one family last year paid out over $12k in medical expenses. Under this plan they would pay $3600.

I'll go out a a limb...from what I've been hearing and ask this: Does this plan "meet" the "insurance plan qualifications" under Obamacare? I'm guessing...Nope. Just sayin

[aboutime]

I'll go out a a limb...from what I've been hearing and ask this: Does this plan "meet" the "insurance plan qualifications" under Obamacare? I'm guessing...Nope. Just sayin


Mr. P. I can't be sure about your question above. But, based on what most of us have seen, in trying to read the more than 2000 pages of the OBAMA-MISERY-CARE-PLAN.

You can probably guess NOTHING meets the qualifications under Obamacare...unless Nancy, Harry, or Barrack say so.

[glockmail]

I'll go out a a limb...from what I've been hearing and ask this: Does this plan "meet" the "insurance plan qualifications" under Obamacare? I'm guessing...Nope. Just sayin I have no clue on that, we just go year to year and try to do what's best.

[gabosaurus]

How does this plan deal with catastrophic illnesses or injuries?
Do they accept those with preexisting conditions?
How does this plan deal with those who need continuing care?
My daughter has a weakened immune system and gets sick a lot. What happens when I go over the limit?

[glockmail]

The basis of this program is a $10,000 deductible policy, so the insurance company monitors how costs have been in a given year for each family, and after the minimum has been spent then they start to pay. They pay 100% of medical costs and there is no limit. The cost savings for them is that they don't have to deal at all with the vast majority of the employees, only the very small percentage who get seriously ill in any given year.

There is about 50 in this group and the base premium is "X" so if an employee has a per-existing condition the base will increase in accordance with their actuarial analysis, facored over all 50 employees.