Any Federal Employees? Insurance question

[mommyrants]

Hey everyone,

My husband just started a new job as a federal employee.

I am overwhelmed by the insurance choices. We need a good PPO - my son has autism and I need to be able to do out of network therapy. We are in Illinois - is Blue Cross our best bet or are one of the group specific plans managed by Unicare or Cigna reasonable? (they are much less expensive)

This is all new for us - so any other "federal employee guidance" would be welcome.

We have an insurance policy under my job, but DH's deductibles are much lower.

 

[Cheshire Figment]

His HR should have a booklet available which gives a brief description of all plans in FEHB. When you narrow it down, they should also have booklets for each individual plan.

Even if you choose wrong initially, Open Season starts in November and any change will be effective the first full pay period in January.

Mike (Retired Federal Employee)

 

[golfgal]

My step-mom is a federal employee and we were just talking about her medical plan (she is retiring soon). One thing her HR person said was the BC/BS has a better nationwide network so if you travel a lot that is of some concern. Also, really look into the coverage for each plan and crunch numbers because while the premiums may be less on one plan, the coverage is better on another making it over all less expensive.

Our old plan, for example, cost us $577/month but we had 100% coverage on everything, including medications after that. Our new plan is about $260/month but we have a $1000 deductible and 80/20 coverage after that. As long as we don't go to the dr it will cost us less but even with our normal check-ups and our regular medications, this plan will end up costing us more out of pocket in the long run. I am NOT happy about the switch but oh well.

 

[auntie]

My step-mom is a federal employee and we were just talking about her medical plan (she is retiring soon). One thing her HR person said was the BC/BS has a better nationwide network so if you travel a lot that is of some concern. Also, really look into the coverage for each plan and crunch numbers because while the premiums may be less on one plan, the coverage is better on another making it over all less expensive.

Our old plan, for example, cost us $577/month but we had 100% coverage on everything, including medications after that. Our new plan is about $260/month but we have a $1000 deductible and 80/20 coverage after that. As long as we don't go to the dr it will cost us less but even with our normal check-ups and our regular medications, this plan will end up costing us more out of pocket in the long run. I am NOT happy about the switch but oh well.

I'm just curious..you pay $577 for full medical coverage Is that just your contribution to it..or the entire cost of it for your family...because that's a great price. (or is that individual coverage)
Here in NY we pay almost three times that for family coverage with BC/BS..we had to change this year to GHI..which is a little less, and so far has been working out, although our deductibles should we need hospital care will be higher. We are self employeed with about 25 employees. No pre existing conditions or medical issues either.

 

[debbi801]

Before making a decision, double and triple check all of the bulletins for each of the possible insurance companies. Then, call each company and talk to various benefits advisors to confirm that they cover what ever treatments are necessary for your son. Make sure you mention his complete dx.

The reason I say that is we were on my PPO insurance plan and while the basic documentation states that they cover Occupational Therapy, Speech Therapy, etc.; the detailed coverage bulletins indicated that they did not cover those therapies for a dx of autism and deemed them experimental. We found this out the hard way. And sadly, there are no laws preventing it (at least not here).

The kids are now all covered under my husband's federal gov't BC/BS insurance plan. It's a bit more money, but they cover the needed therapies. But, there is a specific calendar year limit. So check that, too.

 

[Nik's Mom]

Before making a decision, double and triple check all of the bulletins for each of the possible insurance companies. Then, call each company and talk to various benefits advisors to confirm that they cover what ever treatments are necessary for your son. Make sure you mention his complete dx.

The reason I say that is we were on my PPO insurance plan and while the basic documentation states that they cover Occupational Therapy, Speech Therapy, etc.; the detailed coverage bulletins indicated that they did not cover those therapies for a dx of autism and deemed them experimental. We found this out the hard way. And sadly, there are no laws preventing it (at least not here).

The kids are now all covered under my husband's federal gov't BC/BS insurance plan. It's a bit more money, but they cover the needed therapies. But, there is a specific calendar year limit. So check that, too.

I have found out the same thing for our sons with autism. It's very frustrating!

 

[Uuaww]

I was 23 when I first became a fed-neck and this was by far one of the hardest things to figure out. All I can say is take your time and read everything. You have like 20 choices.

 

[Christine]

I am a federal employee but do not buy the health insurance as I get it for free through my husband's employer. I can only say that most of my coworkers end up going with BC/BS for ease of use and best coverage for the price.

As for specific needs regarding your son's autisum, you probably need to make some calls.

 

[golfgal]

I'm just curious..you pay $577 for full medical coverage Is that just your contribution to it..or the entire cost of it for your family...because that's a great price. (or is that individual coverage)
Here in NY we pay almost three times that for family coverage with BC/BS..we had to change this year to GHI..which is a little less, and so far has been working out, although our deductibles should we need hospital care will be higher. We are self employeed with about 25 employees. No pre existing conditions or medical issues either.

The $577 was what the plan cost. The benefit of living in a state that by law insurance companies are not for profit. The new plan is a group plan and we pay 40% and the company pays 60% so it isn't all that much more.

 

[BlueIrish]

Congrats on your husband getting the job! No clue on your question though

I've been in the process to start a federal job since August 2009, and have been waiting for the medical department to review my chart, the last step. Been three months now in medical review. Long wait since I have zero medical problems. The Feds sure to do slow.

 

[mommyrants]

Thanks for everyone's feedback. We previously had BC?BS and we live in Illinois, which mandates $35,000 a year in Autism therapies must be covered. Once we made deductibles, BC/BS was much better about reimburnsing than Aetna.

Their "reasonable and allowable" is also much closer to realistic costs of therapists.


All of the info is online (for anyone to see) at http://opm.gov - including plan costs, they vary state to state. They do a nice job of having customer ratings of plans. While the lesser known plans get good reviews, I've yet to find anyone who likes them.

Anyway - thanks for the good wishes. He had applied for a variety of very similar jobs over the last 5 years - this was the winner

 

[mhsjax]

Hey everyone,

My husband just started a new job as a federal employee.

I am overwhelmed by the insurance choices. We need a good PPO - my son has autism and I need to be able to do out of network therapy. We are in Illinois - is Blue Cross our best bet or are one of the group specific plans managed by Unicare or Cigna reasonable? (they are much less expensive)

This is all new for us - so any other "federal employee guidance" would be welcome.

We have an insurance policy under my job, but DH's deductibles are much lower.

We have Federal Blue Cross, and we love it.