Comp. changes group medical ins. coverage

[FLMommy]

Florida

I'm not sure if I'm posting this in the right forum, but I hope someone can answer my question. My husband's company has just decided to change their group medical insurance, because there were some high claims last year, and I guess they just don't want to pay more.

Our co-pay now went up by $10 and instead of our insurance covering Participating Prov. at 100%, we now have to pay 20% ourselves. We have a child with an existing brain cndition, (hydro-cephalus) - she is 7 months old and was diagnosed with it after birth. She will need treatment for this for the rest of her life. Our insur. comp was great covering brain surgeries, hospitilization, etc... Now we have to pay up to $4000 a year ourselves which is detrimental to us and we cannot afford it.

Can my husband's company change his medical benefits just like that, and if they can, what are our options?

Thanks for taking the time to read this and reply.

 

[cbg]

Yes, they can. Are you seriously telling me you think the law would prohibit an employer from making changes to their benefit program? Your claims are probably a good part of what made your previous coverage unaffordable to the employer.

Your employer is not required by law to provide you with health insurance in the first place; barring a bona fide contract that says otherwise they can make changes to the plan whenever they choose.

Your options are to find a way to pay your out of pocket claims or find other insurance on your own.

 

[FLMommy]

Thanks for your reply... I think... I have to say this "Are you seriously telling me you think the law would prohibit an employer from making changes to their benefit program" came over as pretty condescending. Not sure if you meant it that way or not, feel free to explain yourself.

Now before you draw any more conclusions about what I "think" - I am from Europe and our healthcare system is a heck of a lot better and fairer to the people. So... that's why I asked the question, because I am not entirely sure how it works over here (although I have an idea with the billions of debt Americans are in... not just from credit cards but so much from medical costs....).

Secondly, to answer your question, YES I do think the law should prohibit companies to a certain extent, especially if a company could more than afford it, and because of the love of money simply don't want to spend any more on the health coverage of their employees. IMO you should not offer a family 100% coverage and then let them get hit them deep in the pocket (for which they are unprepared, especially if a family member has a neurological - or any type of disability) with less than 2 weeks notice. (By the way, last year our premium went slightly down, because of the lack of claims, and now, since there are more claims, they double the co-pay and lower benefits to 80%? Rather then upping the premium again....) I do think there should be some guidelines yes. If you have your own coverage, it's not like your insurance company can just say... oh well, you had a lot of claims... let us change your benefits.... or can they? So why should employers? Perhaps giving us the option of an increased premium with same benefits could do. But this is ridiculous.

 

[FLMommy]

We all have COBRA elegibility, but I guess that doesn't apply here does it?

 

[cbg]

Well, you're not in Europe any longer. I'm sorry if it sounded condescending, but I can't cause there to be a law that makes your employer responsible for YOUR health care costs just because you want there to be one.

In this country, health insurance benefits are not a right. Your employer is not required by law to offer health insurance benefits at all, and they are certainly not required to offer a plan that will mean you don't have any out of pocket costs.

 

[averad]

We all have COBRA elegibility, but I guess that doesn't apply here does it?

COBRA is to continue coverage when coverage would normally not continue (I.E Termination, lack of hours etc.). COBRA cannot be used to continue your previous benefits in your case.

I bet you have a stop loss or out of pocket maximum on your new benefits. When that maximum is met your coverage will pay at 100% of allowed charges.

You old plan was very outdated and I’m guessing cost the employer $950 a member or more. $20 co-pay office call with 80% coverage on lab work etc is good coverage and you should be glad you have it. This isnt Europe or Canada and the waits to see a doctor are alot smaller here.

 

[FLMommy]

Thanks for the replies Appreciate them.

Averad... a lot of people here have that understanding of the waits and all - that they're bigger in places like Canada and Western Europe... I've actually been able to see doctors faster in the Netherlands than I ever have here in the US... Perhaps a thing ppl here believe that's not quite applicable all/most of the time?

 

[rmet4nzkx]

Please contact
Florida Developmental Disabilities Council, Inc.
124 Marriott Drive, Suite 203
Tallahassee, Florida 32301
Phone: 850-488-4180
Toll Free: 800-580-7801
TDD Toll Free: 888-488-8633
Fax: 850-922-6702
also
http://www.shrinershq.org/shc/index.html
Shriners Hospital-Tampa
(orthopaedic)
12502 North Pine Dr.
Tampa, FL 33612-9499
813-972-2250

 

[FLMommy]

RMET thanks, uhm do you want me to contact them with the original q I posted?

 

[Country Living]

Benefit versus entitlement

cbg is absolutely correct with her statements! The majority of us have gone through changes in most of our benefits plans in the past few years - there's been nothing illegal about any of the changes.

Medical insurance costs have risen double-digits each year for several years. My own medical insurance went from a $15 co-pay with no deductible one year to a $1,500 deductible the next year ($4,500 for a family,) which included a 10% co-pay on all approved charges after the deductible was met. The company wasn't making any money off us having insurance - they were already heavily subsidizing the premiums to make it affordable.

Some possible solutions are (and all involve money of some form) 1. Check to see if you can set up a pre-tax Healthcare Spending Account. 2. Change jobs. 3. Check on the price of an individual policy. 4. If you are working, check on insurance with your employer. 5. Use part-time jobs to help pay for the premiums. 6. Move back to Europe (not meant to be condescending - just using your statement that things were better there.)

Good luck.

 

[Gadfly]

You will also notice that the individual tax burden in this country is much lower.