| #1. Networks and Doctors - when you select a plan
be sure to use our Physician
Finder to locate local hospitals and doctors, or search
for them by name. To verify they are in network we also
recommend calling the doctor's office. The best plan on
earth is worthless if you have to drive across the state to
see a doctor. #2. Out of Pocket - is the total
amount you will spend In-Network in a worse case, like
surgery or other hospitalization in a calendar year. Those
small copay's you pay however do not apply to the Deductible
or Out of Pocket. The Deductible is
not the out of pocket. Most $1000 deductible
Copay plans have an Out of Pocket of $3000 because they have
an 80% coinsurance. Regardless of plan type, Copay or HSA,
an individual's out of pocket is generally $3000 per
calendar year.
#3. Coinsurance - the percentage of expenses you
share with the insurance carrier on claims after deductible. For Copay plans
this is usually shown as 80%. Which means Insurance will pay
80%, you pay 20% of
claims after deductible until you hit your out of pocket
maximum. For HSA's we recommend plans
with 100% Coinsurance, which means you pay $0 after you hit
your in network deductible.
#4. Rating Style - all companies produce rates
based on a collection or pool of the people they insure.
They do this in two ways; Form Rating or Community Rating.
Form Rating - Assurant and United Healthcare
Golden Rule rate clients based on the form number of the
policy they purchased and make a pool from those people who
buy that specific plan in a few year time span. These pools
get smaller, older, and less healthy in just a few years so
your renewal premiums go up much faster than a community
rated policy. This allows for lower premiums in the first
year or two of the policy, but also leads to much higher
renewal rates if you stay with this company for multiple
years.
Community Rating - Most other carriers like Humana
and Anthem use a community rating system. This means the
pool of people being rated is from the entire state or
region as you. This means initial premiums may be slightly
higher the first year or so but the renewal increases will
be smaller on average than a Form Rated policy. |