My company insurance is a joke!

As someone works for an insurance company let me tell you, I get it. I really really do. The sad reality is, paying 250 a month isn't actually lot when it comes to the grand scheme of covering medical costs.

If insurance was based 100% on what everyone paid in, and everything was just covered with only that money, the premiums would be through the roof. Not even the roof, you'd be sitting on Jupiter.

Insurance pools are figured up on a few things and the most crucial factor before age, sex, sickness, medical history even comes into play. First, is the insurance company for profit or not-for-profit? The company I work for is not-for-profit, which means 80% of the funds we take in (among a slew of other restrictions we have to abide by) is used for paying claims. The other 20% is to run the business, pay the bills, pay the staff.

When you have a for profit company you have shareholders to deal with.

Then on top of that, the pools are based on history of claims not just from you, but from everyone in your given age range, sex, tobacco use, or if it is a policy through an your job that, they take the history from everyone and try to average it so it can cover everyone. Since it can never be 100% coverage across the board there are a few things that do accumulate to your out of pocket costs:

Premium - the amount of money everyone puts together to be able to pay for the anticipated use of the medical services for the coming year.

Deductible, higher it is, lower premiums get, because higher deductible plans are generally set up for catastrophic issues.

Coinsurance or Stop Loss or Out of Pocket (it is called a lot of things) - this is the break of % between you and your insurance, it might be 20/80, it might be 10/90 or even 50/50. Usually this has a maximum and when it is met, they cover you 100% of the allowable (contracted rate with a given provider who has signed up to be participating with your insurance)

Copays - Really good things. Most people look at them like WTF i have to pay more money? Most of the time that 20-60 copay is covering quite a bit of services, or sometimes it could just be charge drs have for even seeing them, and when I say see them I mean physically walking through their door. (think cover charge at a bar in some cases)

Pre-Existing waiting periods - These things are not here to stick to people with diabetes or tell cancer patients to **** off, these are there because NEWS FLASH medical costs are not cheap, but due to the Portability Act of 1996 with HIPAA, you can provide what is called credible coverage so you can have credit off or remove your waiting periods completely from your previous insurance.

I'd say paying 250 a month for a 500.00 deductible is very reasonable. Most people don't have to go to the doctor for nearly as many serious issues as they would think they need too, so a lot of the times your premiums are paying for the sick people of the pool. Healthcare reform (USA here), grants says most routine services have to be covered 100% of allowable, and this is to try and get people to stay in good health and not need to worry about having a low deductible plan because they plan on living at the doctor.

Trust me when I say this though, you may pay 3k every year but if you truly needed to use your insurance in the case of an accident or whatever, you can rest assured you'll be paying a lot less than the insurance company will.

As far as your prescription, that may be your plan, I don't handle RX at my work, just medical, but it does seem rather high.

In regards to your vision, most insurance carve out routine vision (plain on check eyes for new glasses stuff) and retain the medical side (I got hit in the head with a ball and now my eyes don't work).

And one last big thing, with employer policies, some of your coverage cost is based on what they can afford to pay themselves, high premiums from you can either mean great coverage picked out for you or a really tight ass employer.

Source: http://community.futuremark.com/forum/showthread.php?169298-My-company-insurance-is-a-joke!

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