Home Forums Hunting & Shooting Hunter's Campfire Employer provided insurance

Part of the problem is the crazy prices the doctors and health providers charge.

I went in to the Pt at our local clinic. I/2 hour total time. When the report from our insurance came the charge was over $300.00.

The wife was in the hosp. for some tests. A staff person came in and talked briefly. It turns out he is in the kitchen and plans meals.

Our daughter who is a RN said that they would charge for that even though he did nothing. We have good insurance so the hosp. loads up the costs.

I agree. Wife & I buy coverage on the open market. Over 1K per month for a major medical policy with an 8K annual deductible for each of us. We are in good health with no major medical problems. We save a bit with our HSA, but still write big checks. Part of the joy of being self employed.

Republicans fixed that when they repeal & replaced it when they held the house, senate and Presidency...

If I understand your question, you want to split the 20% share properly between single, two-party and family plans. I sat on a multi-employer plan Board for many years in PA and we dealt with similar issues. The provider will have actual data over multiple years that tell what each plan actually costs. That can be aggregated to show actual ratios for the three plan types. You need to get that data. It is not true that a two-party plan costs twice as much as a single plan, for example, though many of your members might not want to believe that.

With the provider data, then, you can set your rates accordingly, or you can establish a different rate structure. We initially found it was quite common for carriers to use arbitrary ratios between plans instead of actual data-based ratios, and we had to work gradually toward the actual ratios. As part of that effort, we ended up with 5 tiers - single, member/spouse, member/child, member/children, and member/spouse/child(ren). Our members felt this was more fair once they understood the actual data, as opposed to arbitrary ratios. Hope this helps.

Yep. The brief info our CEO gave me on the phone was about a "factor" assignment.
1.0 for single
With a .5 increase added to each in order
+1
Married
Family

Family getting 2.5.

No idea WITH that exactly means.


This is new ground for our union, not sure if it's good ground or deadly?
None of us have a darn clue about any of it, that's why I'm here trying to
gather info. Our staff rep is 250 miles away, we are such as small shop we
aren't a priority. Met him Tuesday, for guidance, but this apportionment of costs
hadn't been brought up yet. Kinda wish we had more time, but it's 830 Monday morning. Not sure we have to write it in concrete then, but the company hasn't
passed on the increases this week, it will be too late to put it in next week's check.
I can't imagine they won't be wanting to get increases started.

However, at one point he mentioned our new, young, employees have helped
a lot. With passing reference to rates dropping, possibly for everyone.


Really uneasy with doing this, raises are usually percents across the board,
this is about deciding how much money is taken from a guys check.

Did you ever get that truck with the electrical issues sorted out?

Those factors are common, but aren't accurate according to the data. A family of 5 is certainly costing a bunch more than single, so a factor of 2.5 is subsidizing them at the expense of single folks. Sounds like it's your call, and I don't envy your position. If you have another person you can share responsibility with, it may help, but I'd still make a quick, determined request for the data.

I'm Chief steward, gonna be president Monday, will have a new steward then.
It's mostly my decision, but it's something we will need to agree on...I hope.


Not sure if management is helping us, or setting up bait.
There has been considerable animosity in the past, I'm hoping with the
staffing changes we can change that a bit. One doesn't have to be nasty to be firm.

FYi - our current factors are (tier, factor, total plan cost):
Single 1, $876.18
Member, child 1.5 $1314.78
Member, children 2.1. $1840.08
Member, spouse 2.2 $1927.80
Member, spouse child 2.7 $2365.38
Member, spouse, children 3.3 2891.70
(Sorry, I forgot they'd split the last 2 apart in my earlier post)

The actual factors for just single, 2P, family tiers would depend on how many of each tier exist, but you can see from my data that our families are running from 2.7 to 3.3 times as much as a single plan (weighted average would be closer to 3.3).

Politically, it may be easier, given your time frame, to live with their 1, 2, 2.5 factors but start them working toward more accurate factors in the future. (I'd probably lean more toward 1, 2, 3.) When requesting data, though, look at their total book of business, since your small group's data could change significantly from year to year.

To get costs from the factors, is fairly simple algebra. If your 20% is, for example, $20,000 annually and you have 6 singles, 9 2P, and 12 family, using the 1, 2, 2.5 factors, solve by:

6×1X+ 9x2X + 12×2.5X = $20,000 which is:
6X + 18X + 30X = $20,000;
54X = $20,000;
X = $370.37. Thus, your annual shares would be:
Single $370.37
2 Party $740.74
Family $925.93

Good luck.

Any interest in stopping by South West Central PA Monday?😉
I'll buy lunch.

Thank God (really!) I don’t have to deal with any of this. I retired in 2010 with very good, fully paid insurance for myself and my spouse, and now have an excellent Advantage plan, also fully paid, while the wife (different one now) also has excellent pre-Medicare insurance. She also has good insurance in China from her employment there years ago and while she was there earlier this year she had all kinds of “work” done, including dental, for a pittance, and in a very short time frame, no waiting for weeks and months for appointments, just walk in and wait your turn. She actually had an eye exam that discovered some wet MD, and the doctor took her right down the hall and had it lasered. Total cost for that and the follow-up treatment was less than $150. Doctors there are respected, but aren’t all that highly paid, and they don’t own hospitals like here.

I'd be glad to if I could - if there's anything I can help with, PM me and I'll try to get back to you. Sounds like a lot of work in a short period of time.

Truly appreciate that, unfortunately it's not any work.
You can tell how ignorant I am, and at this point you have all
the data we have to work with. My big hope is that their age band calculations
help as much as he hinted. If so, I'm hoping we can see everyone's rates drop
a little, or not go up as much as we thought it would. If so, we won't mess with
the multipliers.


So uncomfortable raising costs for some members to save money for others.
I'm comfortable fighting for what's right, even if it is unpopular with some,
this is robbing Peter to pay Paul.
All that ever does is make a sore Peter!🤭🤭🤭

Jokes aside, it's true.


It seems like our factors are in line with what's customary.

Feeelin' your pain. I usually had at least several months to make the changes and had good luck using that time to listen and to educate folks before-hand. Maybe you can work toward that with your employer and carrier for next year. No one enjoys surprises when it comes to health care.

Our contract requires meeting 90 days before the new policy year to discuss plans and pricing.

Didn't happen!

We had meeting the week before.
There is language concerning how increased are split, with 15% being a key number.
The conversation was about the part above 15%, with our side misunderstanding
the whole deal. We were under the impression our cost increases were 1.2%.

The new info was passed out and the s-it hit the fan!

Turned out, the company was right, and had even absorbed $1.4% that should have been put on us!


Lotta stuff happened😡😠😉, that's why the age band thing became an issue.


The whole deal on our insurance is suspect, they are 100% committed to buying
off of a certain agent. Any mention of another agent, if we go to one and get
any quotes...is met with an unbelievable outburst. Total, unreal anger.
Occams's razor and all, there is one obvious reason for that.

You're fortunate in some respects that your family deductible is (only) $2500. Mine is $4000, though it also was partially reimbursed until I retired. The age-banded data may help since younger employees generally cost less, especially since they aren't allowing dependent coverage for new employees. However, you'll likely find the 40-49 year-old and 50-59 bands are the most expensive (not the 60+ year-olds as many would guess). So, having a 65 year-old (and possible a spouse) retire and replacing him with a 30-year old won't change costs as much as trading a 50 year-old (often with multiple dependents) for a 30-year old. Your company may be able to work with your carrier to spread out the increase over a couple years, BUT that may be the wrong thing to do if your plan's expenses keep climbing in the mean-time. I've generally preferred to "pay for what you eat" and be done with it. You don't want to defer some of this increase if next year's costs also climb by 17%.

Also, since they've waited until the last minute to talk with you, make sure they are not making any other changes to the plan - higher co-pays, fewer covered chiropractic visits, reduced mental-health coverages, changing the prescription formularies, etc. Ask them to show the plan description for last year and next year side-by-side.

For the future, you may also think about opening discussions regarding changes that could lower overall costs without decreasing your benefit - eliminating co-pays for generic drugs (an offset could be setting a higher co-pay for a brand-name drug if a generic is available and if the prescribing physician is OK with the generic), or encouraging 90-day mail-order prescriptions for maintenance meds (blood-pressure, thyroid, cholesterol, etc.). Your carrier should be the best source for other such options, but you'll want time to research them and review with your folks before enacting them. You didn't get into HRA/HSA discussions, and that's a whole other matter, but an HSA, especially, can help your employees' net costs, so I trust there is one in place.

Good luck tomorrow.

We certainly don't want to be kicking cans, that's an expressway to ruin.

No HSA.
Not sure if the deductible reimbursement is considered HRA or not, think it may be?

You sent me looking, ICHRAs are an interesting thing that might help the company.
Right now we get paid to Opt Out, an ICHRA would allow the company to offer tax deductible money toward an employee buying their own insurance, tax free for the employee also. New in 2020, not sure how long you've been retired.

I'd make sure the differences in HRA and HSA plans are fully understood if this becomes a possibility - who controls them, etc.. In many cases, HSA's are the way to go. Don't know much about ICHRA's though. Setting up an HSA doesn't cost the employer much of anything and they don't pay FICA on their contributions to it, saving them money, as opposed to using those funds for wages. Since you still have out of pocket costs, one would save you quite a bit.

I wish there was an alternative to employer provided health care that the government wasn't involved in.

I like the idea of having affordable health care options for everyone that isn't tied to whether you have a good job or not.

Obama managed to ruin it for even the people that had really good health care by declaring them "Cadillac plans" ensuring that everyone should have schittier health care for the price of the good stuff.

I hate that bastard

I just retired. My insurance while working was 225 a month for a family plan that was good. They sent me a letter offering Cobra for the.same coverage. 2560 a month.