Does anyone work in HR or know enough about Health Insurance to answer a question?

[shmoogrrrl]

My husband just got a new job and with it comes new insurance. I’ve had Kaiser pretty much since the early 1990’s and now with this new job, we have the chance to switch insurance. Kaiser is still an option, and I have to be honest and say that I’ve had a good experience with them, but being able to pick and choose doctors from a larger list is somewhat appealing so we are thinking about choosing one of the other options (Aetna, BCBS Plans A, B, C, or E).

What I am specifically concerned about though is which of the plans offered offer the best coverage for a few specific things (mainly infertility treatments as we are currently in the middle of them with Kaiser now) Is there a way to find out what they cover BEFORE we pick? If there is, will we need to call each individual company and ask about the plan, or is it something that my Husband’s Human Resources office could be able to handle? I’ve looked on line, but everything is pretty vague.

Thanks! My husband is going to ask the HR department, but he is in training all this week and I am hoping to have this taken care of by July 1 so that we don’t have to pay for another month of Kaiser out of pocket!

Thanks!

 

[Bob Slydell]

The HR department should be able to give you a comparison of the various plans they offer. If not, then go to the insurance company's websites and look up the plan to see what they cover.

 

[jrydberg]

I'm not in HR, but in every job that I've worked, they provided complete coverage information for each health insurance option. The documents can be a bit much to wade through, but if he asks for it, he should be able to get that info from HR. They should have that information readily available.

 

[Dan Murphy]

Something like that will be very specifically be stated in the printed material, whether covered or excluded. I would highly not recommend the verbal yes/no of an HR person, ONLY something in writing, from the insurance carrier. HR can guide, but the policy is what pays or does not pay. As an example, I have BC. It specifically says benefits only for medically necessary procedures, unless specifically covered as a mentioned item, such as an annual preventative well-care exam, routine ob-gyn exam, annual colonoscopy for over 40 year olds and such. Under my plan, again, BC, if it does not specifically mention fertility treatments as covered (they are not medically necessary), then they are NOT covered.

My best to you both.

Dan

 

[Pooh_Friend#1]

I work in HR and their should be a Health Insurance Comparison Guide to help you choose the best one for you. Have your DH ask about the comparison guide. Our comparison guide lists the cost, the benefits, the prescription coverage, etc...pretty much everything you need to know. It even lists the surveys we do to see the satisfaction of employees regarding their insurance coverage.

 

[Microcell]

Originally posted by Dan Murphy
Something like that will be very specifically be stated in the printed material, whether covered or excluded. I would highly not recommend the verbal yes/no of an HR person, ONLY something in writing, from the insurance carrier. HR can guide, but the policy is what pays or does not pay. As an example, I have BC. It specifically says benefits only for medically necessary procedures, unless specifically covered as a mentioned item, such as an annual preventative well-care exam, routine ob-gyn exam, annual colonoscopy for over 40 year olds and such. Under my plan, again, BC, if it does not specifically mention fertility treatments as covered (they are not medically necessary), then they are NOT covered.

My best to you both.

Dan

I work at a DR's office and all day every day that I work I take phone calls asking why ins does not pay and I tell them "Call your insurance and ask them!" They are the best resource! My own sister came in and her HR gave her the phone number for the vision plan (of which we are not providers) and to avoid me bugging her she went to the health plan site and our name was there because of outstanding lease programs, but we were not providers for the health insurance either and she was a Diabetic exam so it should have been considered medical anyway, which HR did not know! She had to pay our of pocket!