What’s the BIG news?
Deductibles on our health plan! As we’ve been communicating since the summer’s Open Enrollment period, we’ll be instituting a deductible on our health plan. Effective January 1st, you may be subject to a deductible when you seek certain services.
What is a deductible and how does it work?
A deductible is the amount you pay for co-insurance based services (things like MRIs, out-patient surgery, hospitalizations) before the plan begins to pay for those services. Effective 1/1/15, you will pay the $250 (the deductible) for co-insurance based services before the plan starts to cover those charges. Once you meet your deductible for the plan year, you will not have to pay it again that year.
It’s important to remember that co-pay based services (doctor’s visits, prescription drugs, etc.) do NOT require you to meet the deductible. You will pay your normal co-pays for these services!
How much is our deductible?
If you are the only enrolled member in your household, your deductible will be $250. If you have one or more spouse/dependents on your plan, your maximum deductible will be $500 for the plan year, regardless of how many dependents you may be covering. Please note that if you’re covering more than one person on your plan, and only one of you has services during the year that are subject to a deductible, you’d only have to pay a $250 deductible for the year.
Here’s an example of how a deductible works:
You need to have a minor surgical procedure on January 2nd. Because you are required to pay co-insurance (instead of a flat co-pay) for this type of service, you will need to pay the deductible in addition to your share of the allowable charges. Let’s say the insurance company will pay $3,500 for this procedure. If you are on the Plus plan, you are responsible for 10% of that allowable charge ($350). You haven’t paid the deductible ($250) yet this plan year. So, you will pay $600 for this surgery ($350 + $250 = $600). Now, let’s say you need another surgical procedure in March. This surgery costs $1,000 and you are responsible for 10% of the allowable charge ($100). Since you have already met your deductible for the plan year, you only pay $100 for this second procedure.
When will I pay the deductible?
In most cases, you’ll pay the deductible to your provider/medical facility after the insurance company has processed your claim for any applicable services.
How can I learn more about what services are subject to the deductible?
Reviewing the Schedule of Benefits is a quick and easy way to see what services are co-pay based (NOT subject to a deductible) and which are co-insurance based (subject to a deductible). If you see a $ co-pay next to the service, the deductible won’t apply. If you see a % co-insurance next to the service, the deductible WILL apply.
Anything else coming up?
New insurance cards! Because of the changes being made to the plan in January, Coventry will be sending all enrolled members new insurance cards in the next few weeks. It is ok to continue using your current cards in the meantime, just be sure to switch out the old card for the new one once you receive the updated cards.
For more detailed information about your employee benefits, our web pages are always available when you are.