Maggots in Grand Junction...help please.

[grskier]

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...

[summit]

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.

[adrenalated]

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.

[El Chupacabra]

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.

[summit]

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.

[Marshall Tucker]

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 :-(

[Whiteroom_Guardian]

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.

[Whiteroom_Guardian]

Surgery scheduled for June 7th. WTF. Should have even fucked around in MT and gone to SLC. I'm not waiting another month.

[altacoup]

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.


Sent from my iPad using TGR Forums

[Conundrum]

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

[Mazderati]

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.

[Conundrum]

Almost as bad as knells.

[Whiteroom_Guardian]

Almost as bad as knells.

Bone apple tea!

[summit]

Relevant to a 2014 surprise bill case, CO supreme court ruled with the patient.



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

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

[skaredshtles]

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

[Conundrum]

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.