insurance

Does anyone have any experience dealing with Cigna HRA or United HRA and WLS? We are having open enrollment and my insurance is with SHBP, all the information I have gathered isn't clear. I just want to make the right choice for me, but I don't want it to have negative consequences for my children and husbands health care needs.

Why exactly are you looking at the HRA?  The HRA gives you access to the PPO networks of both companies.  I wouldn't choose the HRA...maybe I'm mistaken, but my understanding has always been is that they aren't good for people with chronic illness.  Don't know if that affects your situation or not.

And you are right, SHBP is about as clear as mud!  And there is conflicting information from Cigna.  I'm not waiting until November 10th, but I'm going to try and wait until I get consistent information before making my own open enrollment choices.

-Elli

OK from what I've found out about the HRA plans (both Cigna and UHC work pretty much the same way)...  I spent hours on the phone having them explain this to me and this is what I was told....


Let's say the surgery you want costs $10,000.

Well first, b/c of the contract the dr's have with the ins. companies you would get a discounted rate... let's say $7,000.

Ok so the HRA would pay the first $500 which would leave $6500.

B/c you used up your HRA funds the next $1000 (which is the family tier deductible) would fall on you to pay... which would leave you a balance of $ 5,500.

After that deductible is met you would then pay 10% of what is left and the ins. company would pay 90%.. your 10% would be $550

So that means for the surgery you would pay around $1,550 out of pocket...

Let's say you have the surgery on Jan.2 (WE all wish!)

And then you get sick (allergies, cold, kids get sick, whatever) and you need to visit you regular doctor on Jan. 3...

You've used up your HRA... you've met your deductible already...

you would then pay 10% of the cost of the dr's visit (at the discounted rate contracted by the dr and the ins. company)...

So let's say the dr. visit costs a total of $80...

you would pay $8....

you would keep paying 10% untill you reach a total out of pocket max of $4500 for the year...

if you reach this amount then the ins. pays at 100% for the rest of the year..


 

Thanks for the info.  Oout-of-pocket max $4500?!    YIKES! 

Okay, after falling to the ground, I realize you are covering yourself and a family.  I'm single and only cover myself.  My max OOP is $1700 (on the HDHP) or $2000 (on the HRA)...so really, this surgery will make me meet my OOP expense for the year.  THAT I had already figured out.  A good thing too.  I have too many doc appointments.

-Elli

Thanks a bunch you should do a training for the insurance reps. I really feel that I can now make an educated decision.

Thanks.  Funny you should say that.  I was thinking the same thing earlier today.

I may work in the school system, but I'm a speech-language pathologist with a medical setting (not educational setting) background.  Between billing insurance for the private children I see, having worked in medical settings, and dealing with my mom's medical issues (she's disabled, on Medicare...and Medicare stinks), I've learned a lot of the "right questions" to ask.  Sometimes, the difference is just how you "ASK" the question.

The information I've given here isn't always correct...for weeks Cigna was saying all their plans would cover the surgery, but they have updated their information now.  So, as I get new or updated information, I will continue to post.

I just feel as if SHBP has attempted to make this a very difficult process, maybe in an effort to disuade people from getting surgery.  So, I want to help keep people informed.

-Elli