My rant for today

[Lulu54]

My employer started unveiling their new insurance plan for 2014 and I walked away thinking "really?"

They are self-insured and have always offered two forms of health care coverage - a core program that has higher copays and deductibles but very low premiums.  or the reverse - an advantage plan that costs much more, but has lower copays and deductibles. With our medical bills we go with the advantage plan because it works in our favor.

But today I was told in an presentation by the head of our HR department that they are adding a third insurance plan  - one that will have a substantially higher premium and will be the insurance for those of us who have a lot of medical bills and are causing a drain on their medical insurance costs. I'm pretty sure this won't fly and is illegal for many different reasons, but that they would even talk about it out loud surprises me.

My husband asked if that might not be the same as how employers can do a different premium price for smokers vs nonsmokers.  I'm just dumbfounded by this one - stay tuned for an update when I hear more.

[LisaJF]

I can't comment because I'm a "medicaid" insured person.  It's been a long time since I had my own insurance and when I paid out of my paycheck ( back in 2010) I think they took out 328.00 biweekly.  My copays were like 10.00 and prescriptions minimal.  

To be told that there was going to be another increase in my premium and obviously I do have other health issues (lungs) and frequent doctors offices and ERs often, this would NOT fly by me very well.

I'd do exactly what JJ said.  Tape it.  

I can't wait to hear the outcome.

Lisa

[Lulu54]

Technically in the state of Ohio I am disabled and have the permanent handicap placard to prove it.  This should be an interesting week - stay tuned.

[Sailorsong]

Sarah,

  I would think that we are "legally" disabled just as long as a doctor has stated such in writing. As in getting a disability placard for disabled parking. I don't think a company can place a higher standard than what is accepted by the state.

Dennis

[SarahL2491]

hanging on Laura's thread because I saw the ADA comment.  When I was applying for Tecfidera's financial help, the lady kept harping about whether or not I had a "legal disability".

I couldn't decide if she meant I had applied for SS disability or if the letter from my doctor was sufficient.  She got very angry when I couldn't answer her.  So I shut her up, went thru my situation one more time, and told her to move on to the next question.

Any thoughts on "legal" disability for us?  if we have already retired before Dx, why bother going thru the steps for SS since we would not qualify anyway?

[Lulu54]

Lizzie, that is pretty much my thinking as well.  This would have to be illegal on multiple levels. They presented this to one group (faculty) of employees late Friday afternoon and my group(non-faculty)  hears it officially on Tuesday.  I'll be curious to see if there are any changes between the two.

I am still perplexed that they think this is possible.

JJ - great idea and I will do that.  

Interesting that most of you responding are not in the US and express this puzzlement with the rest of us here.  I'm really not going to sweat this one - I can't do that kind of stress.  

thanks all for the feedback.
Laura

[supermum_ms]

I can't really comment on insurance issues but i was thinking, that it might be a good idea to tape that next meeting, it can't hurt and it may come in handy. It's better to be proactive and get what ever comes out of the horses mouth because its not going to be the same on a contract, its usually friendly coloured in legaleeese when in writing.  

My take on this third policy, is that it wreaks!!

Hugs.......JJ

[Cann1980]

Some insurance policies have a cancelable right... Ie my disability policy has the right to cancel all people is one working category... Like welders if they are not profitable. I am an office worker so highly unlikely they would cancel my rating group.

Some medical coverage companies have this right as well... I do not know the stipulations involved. Sorry.
Other than cancelling option #2 entirely which as another post said you u are already  set up in and paid up... They can offer you #3 until they have blue noses but it should not mean you have to change.

This is my opinion... And in Canada which is very different of course... But I can't see your switch being mandatory... Maybe for new employees.
Cheers... Hope all turns out well.

[cubbiesfan918]

At this rate, I hope they have very good Employment Practices Liability coverage. Current, former and potential candidates are all able to file this type of claim. I've seen some ridiculous EPL claims in my life and strongly encourage you to take that route if you have to. I do not think there is any ethical or legal way to determine Category 3 without discriminating. However, I am going to ask a L&H Agent whom I greatly admire and will advise if I find anything helpful for you!

My heart goes out to you at this time, I will keep you in my thoughts!

Truly,
Lizzie

[Lulu54]

Kelly, your situation is pretty much like mine - I figure it costs us 8-10,000 out of pocket a year, counting our insurance costs. We are also Anthem BCBS and I have the advantage plan.  You are right about all those costs that dont count toward our deductible, including office copays and drug costs.

I really think on many levels this is illegal.  First they can't discriminate against people with disabilities due to the ADA. We did not choose to be sick. Different rates for people who smoke is different than separate rates for people who are sick.

Secondly they singled out the people who have no control on their costs as a drain on the entire system, pointing blame at people who really have no control over their health. I hope this news doesn't reach the couple very nice people who are in terminal stages with cancer.Don't they realize most people in our situation already feel that we are a burden in so many ways?

They have now unveiled this plan idea to three different groups in different meeting settings and the fourth group will hear this officially on Tuesday.  I'll be waiting to hear that presentation again and see what adjustments they may have made between now and then- if they have come to their senses or not.

Absolutely everyone I have talked to about this says the same thing - isn't insurance supposed to spread the risk and in the pool you will always have people who need more help or less help and htose costs should balance?  

I'm trying to not be so PO'd and waste energy about this until it becomes official....

[anon07072023]

Whaaaat????  That's a bunch BS!  That makes me mad that they're even allowed to do something like that.  Do you already know that you'll be in the new 3rd insurance plan?  

I've already paid about $7500 out of pocket and they say our insurance is a good one (Anthem BC/BS).  I also pay for the high end one thru my work.  (Well I was - now it's going to be double the monthly premium since I have to go on COBRA).  And that $7500 doesn't include the monthly premium that I pay for coverage or the mileage to and from my appts.  My max out of pocket is supposed to be $2000 - but many things aren't counted to go towards that out of pocket max.  It think it s* cks!

[bubbles_04]

Thats scary Lulu and yeah should be illegal. I thought it was illegal to discriminate agaisnt people with long term diseases in the US??

I hope nothing comes of this.

And how rude to call you a drain on the insurance, you sure as hell didn't ask for MS. Very rude to say that.

The USA needs a NHS, yeah maybe we sometimes have to share a hosptial room but atleast everyone gets care. Obama care?? I think I need to read more on that....

Anyway, hopefully everything will stay the same for you Laura!! xx

[kwarendorf]

Will They be determining who falls into Category 3?

[johnniebear]

WHere we get our insurance is also self funded.   My out of pocket has gone from $1,200  to  $2,500 ..

Med's  from the first $50 then co-pay's of $4-$30.
It's not we pay the first $250 and co-pay's have double.

      "If  you like your insurance you can keep it"
               that's if you can afford.

It's looking like we will be on a State exchange next year at this time.
             " SO if you like you Dr you can keep your Dr"

There So  many changes coming down the pike, some good and some bad.

take care
JB..

[tingletingle]

Booo. Bother. B_m. T*t.

I don't know much about your health system over there but I do know how much the out-of-pockets hurt people like us with a disease or two.

I'm hoping that the policy will ony appy to new employees. They have a duty of care to you Lu. It would be interesting to know if your policy has a sunset or expiry date. As long as you're up-to-date with payments then you've kept your end of the deal. They offered, you accepted and that's a contract. So I've got my fingers and toes crossed that they can't just change this because they got their sums wrong.  

Blessings
Alex

[maxthecat43]

Yeah, it doesn't sound like they can legally do that to you.

[doublevision1]

sounds fishy but you'd think they did their research?