What are some
current plans that
work well when
maternity coverage
is not needed?
Maternity is one of
the single biggest
determinants on
health plan cost
when researching
individual health
insurance plans
in the California
market. It's
easy to see why when
a simple delivery
can run $10,000 and
an uncomplicated
C-section can run
$20,000.
Maternity is
probably the only
health care service
you can actually
plan on to some
extent. No one
plans for a broken
bone. Health
care costs have
spiraled up over the
last years primarily
because of facility
based care
(translated as
hospital based care)
and maternity is
deeply dependent on
such care. So
if maternity is
something you may
need now or possibly
in the future, it's
probably best to
stop reading.
Be careful not to
assume that you can
get a non-maternity
plan now to save
money and switch in
the future as you
get closer to the
need for maternity
coverage. If
your health changes
or if you become
pregnant, it might
be impossible to
switch to a plan
that covers
maternity.
Non-maternity health
plans on the market
Let's look at some
plans on the market
for people who will
definitely not need
maternity coverage.
First,
HMO (Health
Maintenance
Organization)
type plans have
become pretty
expensive in
comparison with
mid-level PPO
options. The
HMO plans usually
cover maternity
anyway which is
partially why they
are so expensive so
we'll concentrate
more on PPO plans
which is were the
market has been
heading.
PPO (Preferred
Provider
Organization)
plans offer a full
range of
non-maternity health
plans but on a
practical sense, it
comes down to really
two ways of
approaching health
care needs. We
will look at Anthem
Blue Cross as an
example since they
are both a strong
carrier and priced
well. First,
are we going for?
Well, we want
comprehensive
coverage. This
means we do not want
to find big holes in
our coverage later
on relative to the
other plans on the
market. We
also do not want the
richest plans.
When you're paying
for your own health
insurance, the
annual premium
difference between
various plans is a
major consideration
if two plans differ
by how they treat
office copays and RX
copays but the
premium difference
is $1000.
$1000 pays for a lot
of copays in a
year's time.
Based on this, start
by looking at these
two suite of plans.
Lumenos HSA plans
(non-maternity
option) or PPO $3500
HSA compatible plan
This is a simple
plan as far as
health insurance is
considered.
Essentially, you
have a
high deductible
for which all
covered benefits are
subject to.
The Lumenos plans
carves out some
preventative benefit
coverage which
is very useful for
those that require
this. Either
way, the theory is a
high deductible to
keep the cost down.
This is best suited
for:
1. Older
individuals (since
age is the primary
driving force of
cost)
2. People who
are most interested
in
catastrophic health
insurance to
cover big bills
3. Those
individuals that
wish to take
advantage of the the
tax benefits of an
HSA.
The pricing tends to
be some of the
lowest on the market
for comprehensive
coverage. One
note...the
deductible for two
or more people on
one policy is double
and cumulative for
all family members
on the policy.
For example, if one
person's deductible
is $1500, a family's
cumulative
deductible would be
$3000 and all family
members are working
towards the same
deductible.
Smart Sense PPO
plans with no
maternity coverage
The other suite of
plans to compare is
the
Smart Sense PPO
plans with
Comprehensive RX.
You have an option
of deductible amount
to choose from which
drives the cost of
the monthly premium.
The major difference
between these plans
and the HSA plans
mentioned above is
that office copays
and RX coverage is
not subject to the
main deductible.
Also, the main
deductible is per
person with the
Smart Sense plans
while the HSA plans
are cumulative
deductibles.
You can run your
instant quote
here to research
both the HSA
compatible plans and
the Smart Sense
plans for
comprehensive,
non-maternity health
insurance.
Make sure to read
through the
brochures and please
let us know if we
can help in any way.
