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I'm currently involved with an insurance price increase issue at work,
and need help/information.

Pretty sure only employers and agents deal with this, but if you truly KNOW
how it works chime in.


What I thought I knew went something like this,
A survey of workers is taken, the insurance company then sets premiums for each
class of policy, ie.single, married, family...


Now I'm being told,
The survey is done, a net premium is set.
The company then uses an in house formula to decide how the various policies
absorb their share.


In our situation, it's an 80/20 split on premiums, the company decides how
the different policies share their 20%.

Which is correct?

As a union officer (you might not want to help me now) I need to understand
how this all works. To assure everything is being done by the book.
When I ask for raw numbers, I was...stalled. Then recently this was explained.

Monday we have a meeting about all of this, and my boss wants us to be part
of setting the fee structure.
I really, really am unhappy doing that, but...here we are. Got more than I bargained for!


So business owners can/will anyone tell me if this is how it works?
I understand not helping, not wanting employees to know this is how it's done.
Not that it is wrong, but that employers decide who shares more burden than
others in the employee contribution.


Or, am I wrong with both scenarios?

Years back[until the big O pucked it up worse] we did 'cost sharing'
Females were much highr[and older females were out of sight high].

I averaged the price -total premium divided by total employees.
We paid 50%

Don't know if that is what you are looking for or not.

Don't know either really.


Told we get a lump sum price, then divide it up among the,
Single
Single+kid
Married
Family plans.

This (recent) position has opened my eyes.

Always knew the rough annual cost for my insurance,
obviously we'll aware of what came out of MY paycheck.

Now I realize that my $99 (20%) payroll deduction represents a $400 cost to the company and a total of FIVE HUNDRED $$$$! Per week cost for insurance!

We have new guys in bottom positions not taking that much home.

Hell, it takes $12.50 an hour to gross that!

And we got a 17.4% insurance increase.

However, it appears our inquires have caused a hard look at the policy. (Average age has decreased as guys are replaced)
I'm lead to believe that the numbers will be better Monday.

On the one hand I hate to gripe, we have a Gold Family policy for $99/we last year,
$115 or less this year. I know many others pay more for less.

On the other...our price keeps climbing, and every year the policy decreases coverage.
Can't bitch much, it's the same for everyone on that front.

Insurance is one of the biggest scams this country has going. The rates are ridiculously high and they pay for less every year. We just had a 16.4% increase starting nov 1st. We have had numerous increases in the past years and we get more bills in the mail now than ever before. its utter bullchit and I do not know the answer. Ive tried to shop around to see if I can find something better, but i have yet to come across a plan. We pay $380 a month out of pocket currently, work takes care of the rest. Thats just for single person coverage too. Adding my wife or daughter takes it up over a grand. Luckily, the wifes work has decent insurance. If I could find a plan that cost me around $400 a month or less, I would opt out here because we get a $100 credit back if we leave the plan. Like I said, its one giant scam

We get $500 to opt out of a family plan, single is around $200.


Last contract, they implemented a policy of worker only insurance for
new employees. Non-negotiable!

I fought that bitch tooth and nail,
the #%^&&^=÷#'! membership couldn't see past our 4 5% raises and passed it.
Now, they see the new guy's faces and regret it.

Not to hijack your thread.
I pay $1650/mo. for a family plan, United Healthcare. I'm about to start looking at these Christian medshare systems. Anyone have any experience with them? The good, bad, ugly?

$425 per month is my share. Me, wife, youngest son. Coverage is 90/10 with $400 dedcutible for each person. Max out of my pocket is $2000 total for the year.

I ain't complaining, except it keeps going up $25-$40 a month every year. Three years ago, I was insuring 4 of us for $325 a month.


Clyde

Edited to add, Blue Cross/Blue Shield.

Healthcare in this country is a scam, not just the insurance. We're the only developed country in the world that doesn't have a national healthcare system. Our government already pays more GDP % on healthcare, than any other country. In some cases over 4X, yet there isn't universal coverage. Look at the trend in this chart and look how the gap continues to grow.

US Healthcare costs

Yep, that's the way to streamline, cut costs, and make American Health Care more efficient. Just turn it over to the Federal Government. LOL

Guys, I can only feel sympathy for your pain over insurance costs. It has been a tough fight every negotiation since Obama took office. And we have sacrificed in other areas, but we still have zero premiums on our health care. So, yes, the young single men and women are subsidizing their older workmates with spouses and children.

I say we, but I am recently retired and am with United now with our Medicare plan.

From what I could see in your link, it doesn't take into account the high percentage of taxes paid in order to get that "free" gov health care. Canada has something like a 40% +/- tax rate for that "free" health care. (Province+federal) LOL

And it is so efficient, that no one from Canada ever comes to the US to have an MRI or other common in the US procedures. LOL (place sarcasm emoji here)


Clyde

My company is currently exempt from the shared responsibility portion of the ACA, so small enough that we can offer only 1 level of coverage to everyone. Things are a bit different for larger companies that can offer multiple levels of coverage.

But ultimately the costs are closer to your understanding than what you are being told. The company provides its employee demographics to candidate insurers, and for large ones their claim history. The insurer comes back with costs per coverage level per employee who elects coverage. The employer then whacks that up according to their split, fully paid, 80/20, etc. to determine how much the employee will pay.

Contracts typically have provisions like caps on total claims, provisions for lowering costs if the number of employees increases, etc.

I have never seen a process that worked like you are being told. A net premium would have to make assumptions the number of people electing coverage or choosing coverage levels. I can't see aa health insurer risking every employee electing Platinum family coverage, when their quote assumed 90% bronze.

You guys are all wrong. Obama fixed this and made it affordable years ago.

My wife and I used Samaritan Ministries when I retired, we never used it, they don’t pay for office visits, or have prescriptions coverage. I think it cost my wife $250.00 a month. It’s good for hospital bills. Probably the best medishare coverages out there.

Why wouldn’t the employer use data from the last ten years to figure out where the dollars go on average and then apply those numbers to single, married, single with dependents , family etc to set the final proportions ? Seems too fugking easy

$425 for you, spouse, and son seems pretty reasonable today.

We are small like you.
We have a Gold policy, the only choices we get is in who the employee covers,
and to opt out. Opting out requires proof of other insurance.

Currently about one third opt out, using a spouses plan instead.
That's getting harder to do, so many companies do not offer coverage to anyone
but the employee. Or they have to prove no other option.



I think our deductible on the whole family is $2500.
However, our company will reimburse us between half to three quarters of that.


I'm glad to see some still have great insurance.

I was just about to point this out as well. This is a VERY low cost for such an expensive plan. This is the type of benefit that would entice folks to jump ship elsewhere and join a business.

I can tell you how it works for companies in Maryland that have under 50 employees. I think they call it the small business pool. The insurance company gets a detailed survey of each person (employees, spouse, children) by age and then provides a specific rate for each person. I think the only question they ask is if you smoke tobacco. The allocation of cost is 100% done by the insurance company. Years ago the rates were more generalized but this is how it works today. I will also add that this is a fairly young company and since they did not exist before Obamacare was enacted there are no grandfathering provisions of pre-Obamacare plans available to them.

That sounds like a great plan too. IIRC, you get family coverage for $100 a week and your employer covers up to 2/3 of your $2500 deductible?? Not sure what your co-pays are, but that sounds like a super deal. Just for fun, call around and price a plan like that as an individual. The cost would curl your hair!

I agree, very reasonable. The company I work for has 10,000 employees, so there is buying power in numbers.



Clyde