Comments on: Would someone explain the deductible/OOP?

By: Michael

Michael — Wed, 06 Jan 2010 15:31:59 +0000

You know what… never believe those HSA stuff.. they are just trying to make a profit out of it…. you are here asking the difference not about looking for a policy…anyway,

DEDUCTIBLE

this is an amount that needs to be satisfied before we pay for a certain percentage….

Example. your deductible hasnt been satisfied yet , and once you render a procedure lets say surgery, this will be sent to the insurance and the insurance will apply them to the deductible…. once the deductible has been met.. let say your insurance is 80 / 20, meaning insurance will cover 80 percent of the allowable amount and 20 percent will be your responsibility. once deductible has been met then insurance will cover 80 percent and you will only pay 20 percent….

OUT OF POCKET (OOP)

this is an amount where once you reach that amount , the insurance will cover 100 percent of the allowable amount… that means that you will never pay anything or the 80/20 will not apply any more since OOP has been met….

check out some procedures because there are some procedures where deduct / and OOP doesnt apply….

HEALTHLINK AGENT
References :

By: Insurance Made Easy.biz

Insurance Made Easy.biz — Wed, 06 Jan 2010 14:52:59 +0000

Well done by Christine R.
You also need to know this plan is a Qualified High Deductible Health Plan which makes it HSA compatible. That means you can open a Health Savings Account and deposit up to $2,850 each year. The deposit is written off your taxes just like an IRA. If you spend the money on qualified expenses the account remains tax free. If you don’t spend the money it remains in the account for future use. Qualified expenses include the decutible, dental, vision over the counter medications, etc.

This plan has a lifetime benefit of $25 million most other individual plans cap at $5 million

Michael,
The HAS’s actually cost me ( the broker) money. High deductible plans have lower premiums which = lower commission.
The HSA bank account provides no benefit to the broker/agent and saves the insured hundreds if not thousands over traditional plans. I suggest you learn about HAS plans if you are going to comment on them. I woul dbe glad to run you a quote you can use to compare to health link.
http://www.hsainsider.com/
References :
Independent Broker 9 years

By: Christine R

Christine R — Wed, 06 Jan 2010 14:30:59 +0000

Here we go…

You are responsible to pay the first $2850 of your covered medical expenses. This includes the cost of a doctor’s office visit, prescriptions, an ER visit, etc. After that, the insurance company will cover 80% and you cover 20% until you’ve paid another $2,000 out of pocket. At that point, the plan will pay at 100%.
So, if you are in a car accident, spend a week in the hospital, and rack up $30,000 in medical bills, you will pay $4850 out of pocket. All of your doctors visits, prescriptions, etc for the rest of the year will be at no cost to you.
If , on the other hand, you have a couple of doctors visits, a specialist visit or two, and routine lab work over the course of the year, you will likely not meet your deductible and the plan will pay nothing. The deductible is annual so if you have $2800 in costs every year for ten years, the plan still would have paid for nothing.

It is important to note here that the deductible, co-insurance, and out-of-pocket max are all for covered expenses. If you go for routine accupuncture or something like that, none of the money you pay there will count into the deductible, etc.

The only things that will be covered before you meet the deductible are those items specifically listed as being exempted from the deductible (like children’s immunizations).
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