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  1. #201
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    Jan 2006
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    Quote Originally Posted by tgapp View Post
    I guess a little bit of nuance to my statement:

    You'll have an in network max deductible and an out of network, so yeah, it behooves you to do your homework and make sure that both the provider AND the hospital/urgent care/whatever are in network. Sometimes, one can be in network but the other will be out of network.

    Sent from my Pixel 6 Pro using Tapatalk
    I forget about that part... I do everything at one place because my wife works there...
    www.dpsskis.com
    www.point6.com
    formerly an ambassador for a few others, but the ski industry is... interesting.
    Fukt: a very small amount of snow.

  2. #202
    Join Date
    Oct 2003
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    9,300ft
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    My company insurance plans all have no listed out of pocket maximums for out of network. Out of network simple is "not covered" except for emergency care.
    Quote Originally Posted by blurred
    skiing is hiking all day so that you can ski on shitty gear for 5 minutes.

  3. #203
    Join Date
    Dec 2006
    Location
    Your Mom's House
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    7,614
    Quote Originally Posted by Summit View Post
    My company insurance plans all have no listed out of pocket maximums for out of network. Out of network simple is "not covered" except for emergency care.
    Your plan is through a healthcare system though, right? That tracks with my wife's old plan with a large healthcare system - it highly incentivized having everything done within their system and highly discouraged having anything done anywhere else.

    Every plan I've had (both employer provided and self purchased) has set the out of network out of pocket maximum at roughly 2X the in network value. With that said I've been on the same plan for like 8-9 years now.

  4. #204
    Join Date
    Sep 2004
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    LV-426
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    Quote Originally Posted by Summit View Post
    My company insurance plans all have no listed out of pocket maximums for out of network. Out of network simple is "not covered" except for emergency care.
    Our plan is the same - it's a marketplace plan with no coverage out of network, except for what the ACA requires (such as emergency room treatment).

    To cover that gap, I bought an annual travel insurance policy from Allianz. Worth looking into if you have a similar insurance plan. For two of us, base plan was around $300 for the year. There are higher tier plans for more coverage too - look around on the website.
    https://www.allianztravelinsurance.c...rips-basic.htm

    It's a reimbursement style plan, so you pay out of pocket and submit records for reimbursement. Covers medical expenses so long as it's 100 miles from your home, or farther, with some exceptions that are worth reviewing - IIRC stuff like mountaineering, skydiving.

    I basically wanted something to cover if we're on a trip, get sick or injured, and want to go to an urgent care (our health insurance covers in network urgent care only, and unfortunately there aren't a lot of them). It also has typical travel insurance stuff like rental car coverage and lost baggage.
    Quote Originally Posted by powder11 View Post
    if you have to resort to taking advice from the nitwits on this forum, then you're doomed.

  5. #205
    Join Date
    Oct 2003
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    9,300ft
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    20,047
    Quote Originally Posted by adrenalated View Post
    Your plan is through a healthcare system though, right? That tracks with my wife's old plan with a large healthcare system - it highly incentivized having everything done within their system and highly discouraged having anything done anywhere else.

    Every plan I've had (both employer provided and self purchased) has set the out of network out of pocket maximum at roughly 2X the in network value. With that said I've been on the same plan for like 8-9 years now.
    No out of network coverage period whether you are on the health system's self-insured plan (can only go to the health system) or whether you are on the United Healthcare HSA plan.

    Also, can we talk abut how HRA plans are evil corporate slavery? HRA is exactly like an HSA account except you get fucked and there is no potential retirement benefit. You put your money into a carryover account, then the company keeps it if you leave or they fire you. This is the new hotness in corporate America meant to "support employee retention." Why is this allowed to exist? I expect most companies to stop offering HSA plans.
    Quote Originally Posted by blurred
    skiing is hiking all day so that you can ski on shitty gear for 5 minutes.

  6. #206
    Join Date
    Mar 2005
    Location
    SE USA
    Posts
    3,423
    Wow what a read.

    FWIW non-dominate anterior dislocations ending my skiing days. 3 visits to the mountain followed by 3 visits to the ER, they had to put me under every time :-(
    "Can't you see..."

  7. #207
    Join Date
    May 2008
    Location
    On a genuine ol' fashioned authentic steam powered aereoplane
    Posts
    15,121
    Quote Originally Posted by Marshall Tucker View Post
    Wow what a read.

    FWIW non-dominate anterior dislocations ending my skiing days. 3 visits to the mountain followed by 3 visits to the ER, they had to put me under every time :-(
    Yeah that's why I'm getting mine fixed.

  8. #208
    Join Date
    May 2008
    Location
    On a genuine ol' fashioned authentic steam powered aereoplane
    Posts
    15,121
    Surgery scheduled for June 7th. WTF. Should have even fucked around in MT and gone to SLC. I'm not waiting another month.

  9. #209
    Join Date
    Jan 2011
    Location
    Alta
    Posts
    1,984
    Bummer. I think it took 2 1/2 weeks from meeting ortho to getting cut for me at the UofU and I thought that was slow. Did take me to long to get to actually see the ortho but that’s because my injury happened at work and WCF are mother fuckers.


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  10. #210
    Join Date
    Oct 2005
    Location
    Idaho
    Posts
    10,314
    Quote Originally Posted by Summit View Post
    Also, can we talk abut how HRA plans are evil corporate slavery? HRA is exactly like an HSA account except you get fucked and there is no potential retirement benefit. You put your money into a carryover account, then the company keeps it if you leave or they fire you. This is the new hotness in corporate America meant to "support employee retention." Why is this allowed to exist? I expect most companies to stop offering HSA plans.
    You might have your acronyms crossed. Health reimbursement arrangements are unfunded and paid by the employer to employees for eligible reimbursements. FSAs are what I think you might mean. FSAs have been around forever and will not be a death nail to HSAs for many reasons.

    /insurancenerdery

  11. #211
    Join Date
    Dec 2009
    Location
    The Mayonnaisium
    Posts
    9,468
    Death nails will get you every time.

    With respect to OOP maxes, don't look past the fact that maxes only apply to visits/procedures/therapies/equipment the insurer deems covered. I had two hip surgeries and crutches were not covered. Crutches. For an orthopedic surgery. Same for the constant motion machine and same for part of the PT.

  12. #212
    Join Date
    Oct 2005
    Location
    Idaho
    Posts
    10,314
    Almost as bad as knells.

  13. #213
    Join Date
    May 2008
    Location
    On a genuine ol' fashioned authentic steam powered aereoplane
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    15,121
    Quote Originally Posted by Conundrum View Post
    Almost as bad as knells.
    Bone apple tea!

  14. #214
    Join Date
    Oct 2003
    Location
    9,300ft
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    Relevant to a 2014 surprise bill case, CO supreme court ruled with the patient.



    https://www.coloradopolitics.com/cou...d44b6034f.html

    Quote Originally Posted by Conundrum View Post
    You might have your acronyms crossed. Health reimbursement arrangements are unfunded and paid by the employer to employees for eligible reimbursements. FSAs are what I think you might mean. FSAs have been around forever and will not be a death nail to HSAs for many reasons.

    /insurancenerdery
    That is not quite right.

    HRAs can be partially funded by the employer like they might help fund a portion of an HSA, "here's $500/yr for you." The employee ultimately funds the rest of the HRA at their discretion like an HSA/FSA. HRA can rollover the full balance year to year like an HSA. Unlike the HSA, if you are no longer part of the company, the company keeps the entire HRA balance whether it is company or employee funded.

    This lets the employer hold hundreds or thousands of dollars of anti-severance over employees as leverage for retention. The bean counters also view it as a way to make turnover cheaper.

    HRA=teh debil
    Quote Originally Posted by blurred
    skiing is hiking all day so that you can ski on shitty gear for 5 minutes.

  15. #215
    Join Date
    Dec 2016
    Location
    In a van... down by the river
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    9,805
    Quote Originally Posted by Summit View Post
    Unlike the HSA, if you are no longer part of the company, the company keeps the entire HRA balance whether it is company or employee funded.

    This lets the employer hold hundreds or thousands of dollars of anti-severance over employees as leverage for retention. The bean counters also view it as a way to make turnover cheaper.

    HRA=teh debil

  16. #216
    Join Date
    Oct 2005
    Location
    Idaho
    Posts
    10,314
    Quote Originally Posted by Summit View Post

    That is not quite right.

    HRAs can be partially funded by the employer like they might help fund a portion of an HSA, "here's $500/yr for you." The employee ultimately funds the rest of the HRA at their discretion like an HSA/FSA. HRA can rollover the full balance year to year like an HSA. Unlike the HSA, if you are no longer part of the company, the company keeps the entire HRA balance whether it is company or employee funded.

    This lets the employer hold hundreds or thousands of dollars of anti-severance over employees as leverage for retention. The bean counters also view it as a way to make turnover cheaper.

    HRA=teh debil

    https://www.healthcare.gov/glossary/...%20arrangement.

    Health Reimbursement Arrangements (HRAs) are employer-funded group health plans from which employees are reimbursed tax-free for qualified medical expenses up to a fixed dollar amount per year.
    https://www.irs.gov/pub/irs-drop/n-02-45.pdf

    An HRA is an arrangement that: (1) is paid for solely by the employer and not provided pursuant to salary reduction election or otherwise under a § 125 cafeteria plan; (2) reimburses the employee for medical care expenses (as defined by § 213(d) of the Internal Revenue Code) incurred by the employee and the employee’s spouse and dependents (as defined in § 152); and (3) provides reimbursements up to a maximum dollar amount for a coverage period and any unused portion of the maximum dollar amount at the end of a coverage period is carried forward to increase the maximum reimbursement amount in subsequent coverage periods.
    An HRA does not qualify for the exclusion under § 105(b) if any person has the right to receive cash or any other taxable or non-taxable benefit under the arrangement other than the reimbursement of medical care expenses.
    Employer contributions to an HRA may not be attributable to salary reduction or otherwise provided under a § 125 cafeteria plan.
    An arrangement is not treated as an HRA if the arrangement interacts with a cafeteria plan in such a way as to permit employees to use salary reduction indirectly to fund the HRA.

    Maybe they are using the terminology incorrectly. I'd be interested to see how it operates. Of all the bullshit I post on TGR, this is a topic I actually know a bit about.
    Last edited by Conundrum; 05-20-2022 at 09:27 PM.

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