Saturday, August 27, 2011

Top 3 Differences Between Carriers

Each carrier the shoppe represents has their own place in the market, behind monthly premiums.  Below are the 3 key differences per carrier the shoppe represents.

BCBSIL

  1. ER is offered at 3 coverage levels, dependent on plan  to either cover the bill 100%, waive the deductible, requiring the insured to pay 20% or subject the bill toward the plan deductible (HSA plans)
  2. There are no prescription copay's unless a $500 or lower deductible is selected to then receive a $10 copay for generics.  All other plans have the insured paying the contracted rate towards the plan deductible to then be covered at 80% or 100% once satisfied
  3. 12 month waiting period for pre-existing medical conditions; waived if insured has 12 months of credible coverage with another BCBS plan
Humana
  1. ER is subject to the plan deductible with optional SAB benefit to be purchased which will reduce ER bill by $1,000 or $2,500, and will only reduce for accident, not illness
  2. All plans other than HSA provide an immediate $15 copay for generic drugs and have a separate $500 and higher prescription drug deductible that the insured pays the contracted rate towards for Preferred and Brand Name drugs before copay's are received
  3. Waives the 12 month pre-ex waiting period for conditions that are disclosed on application, leading to a possible premium increase to cover risk from day one of coverage
UnitedHealthCare
  1. All plan deductibles, no matter the plan, are considered "decreasing"...meaning that each calendar year the deductible has not been met it will reduce by 20%
  2. Many optional benefits such as SAB rider, lower prescription drug deductible and limited office visit copays (to reduce premium)
  3. Waives the 12 month pre-ex waiting period for conditions that are disclosed on application, leading to a possible premium increase to cover risk from day one of coverage
Aetna
  • 90% of the time, Aetna will be the most expensive in plan premium
  • Aetna does not place condition specific exclusion riders and will increase premium to cover medical risk
  • 12 month waiting period for pre-existing medical conditions to be waived if insured has prior credible coverage for 12 months, not carrier specific
Celtic
  • 80% of the time, Celtic will be the lowest in monthly premiums for applicants 19-35 years old
  • Limited office visit copay plans
  • After 1st year of coverage, plan will renew semi-annually
Assurant
  • 90% of the time, Assurant will be the most expensive in plan premium
  • Offers 3 networks to choose from to reduce monthly premium
  • Non HSA plans start with a $700 facility fee copay in addition to the deductible that does not apply to the plan

I hope this has been helpful.  Please contact the shoppe with further questions.

Sincerely,

Jordan

3 comments:

  1. When you're on your own, finding individual health insurance for you and your family can be a challenge. If you're feeling overwhelmed, we understand. First of all, you'll need to decide whether your most suitable choice is an indemnity (reimbursement) plan or a managed care plan.

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  2. Medical plans include fee-for-service wherein doctors and other providers receive a payment that does not exceed their billed charge for service provided.

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