SupplyWorks - Small Business Owners: Break Up With Your Health Insurance Plan - 6 Hacks for Taking Control of Your Healthcare Costs

This is largely government initiated / backed. From a quick google I do see some private companies (probably small??) trying to do similar things perhaps more broadly, e.g.

You may also be interested to see what Press Ganey claims, as they’re the ones who really have “owned” the HCAHPS survey distribution / collection that feed the government backed hospital compare site (at least partially, I think hospital compare also takes into account some other quality metrics)
NACDS Total Store Expo
NAHQ 39th Annual Educational
ASHRM 2014 Annual Conference & Exhibition
NACDS - National Association of Chain Drug Stores. They have a conference.
ASHRM: American Society for Healthcare Risk Management. They have a conference.
IHI: Annual National Forum on Quality Improvement in Healthcare.
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Quality, Access and Cost are Keys to Healthcare Reform, Subramaniam Ramanarayanan




Preventive Care is covered at 100%. You do not have to pay anything for preventive care. Preventive Care includes … However, only certain operations are considered as eligible for preventive care. For example, if you visit your doctor for a regular preventive check-up, and the doctor see that something may be wrong with your body, and he tells you that you need to take an X-ray so that he can further examine it, that X-ray operation is not considered as preventive. Be sure to ask your doctor or your health administrator to determine if that operation is considered as preventive. If it is not considered as preventive, then you need to find out how much that will cost you.

Children, adult children, up to the age of 26 were mandated that they can stay on your insurance plan. Prior to healthcare reform, your dependents have to be a full-time students in order to stay on your plan once they are over 18. Now, they can be between 18 and 26, stay on your plan, there is absolutely no requirement. They don’t have to be a student. They don’t have to live with you. You don’t even have to file them on your tax return. They can live in another state, married to someone else, and be on your insurance. You just simply have to say that they are yours. That is all you have to say. You have to pay for the dependent cost. Healthcare reform expands the definition of a dependent.

Life time limit was eliminated. Prior to healthcare reform, on PPO plans, there was a maximum amount the insurance company will pay mostly 5 or 6 millions dollars in your lifetime. That was eliminated. So if you have some catastrophic illness or injury, you wouldn’t get into a situation where you wouldn’t have insurance anymore.

Pre-existing conditions are waived for everyone in 2014.

If you are an employer with more than 50 employees, you have to offer insurance or be subjected to a penalty. And if you offer insurance, it has to meet some criteria. It has to be affordable (as defined by the government), and it has to meet some minimum essential values.

If you do not have acceptable health insurance, you receive a penalty. The penalty is 1% of your income in 2014 paid in 2015, and 2015 is 2%, and 2016 is 2.5%

Healthcare reform establish the market place for healthcare, also known as the healthcare exchange. Each state is tasked with establishing the healthcare exchange. In California, the exchange is There are four levels of options within the exchange: Platinum, Gold, Silver, and Bronze. These are not government insurances. These are insurance companies within the exchange, offering these 4 levels of benefits. You, as an individual can shop on the exchange. You, as an individual, if you meet certain income requirement, could be eligible for subsidies to pay toward your premium, which make it affordable. There is another caveat. It also says that you have to not have access to affordable care (either through your employer’s insurance plan). Affordability is defined as the premium for your health insurance cannot cost you more than 9.5% of your income. If you already have insurance through your employer, you do not have to register in the healthcare exchange.

$20 co-pay if we go to a primary doctor. $25 co-pay if we go to a specialist. If we need other services, such as surgery, hospitalization, lab, X-rays, MRI, CT scan, anything like that, we have to pay a deductible. We have to pay a deductible before. What is a deductible? A deductible is the amount of money you pay before the insurance company pay, very much like car insurance. The deductible on this plan is $250 per individual, $500 per family. After you pay the deductible, you then share the cost. The cost share is 20%. You will pay 20% of the negotiated bill up to the out-of-pocket maximum. The out-of-pocket maximum on this plan is $2500 per individual or $5000 per family. These amounts are reset on January 1st. So the first time you go in to get a lab, X-ray, surgery, anything like that, you pay the first $250. If you are hospitalized on this plan, if you have not met the deductible, you pay the deductible, then you have a co-pay of $150, plus 20%. For out-patient surgery, labs and X-ray, you pay 20% after the deductible. Complex surgery, MRI, CT scan, you pay 30%.

Chiropractic is covered on this plan. You have $20 co-pay. You have 12 visits per year. You do not have to pay the deductible first.

Prescription, we have only one card and we can go to any pharmacy we want. You go with your Aetna card. You pay $10 for generic, $20 for medications that are one Aetna list, $35 for drugs that are not on their list (non-formulary). If you take compound medication which need to be made by the pharmacist, you have to pay 20% of the cost of that medication up to the maximum liability of $150.

The deductible and the out-of-pocket cost is annual. The rest is per occurrence.

If we are traveling in a remote area, where no one is accepting your insurance (you are forced to go out-of-network), and you have to go to a hospital, it is treated as in-network because you do not have an option.

On Delta Dental, we have a calendar year benefit. We have a calendar year deductible of $50. You pay the first $50 before Delta Dental pay anything beside preventive. Once you pay $50, Delta will share in your cost up to the maximum benefit of $1500. For preventive services, they pay in full. If you need a filling, a tooth extraction, Delta will pay 80%, you’ll pay the first $50 for the calendar year, and you pay 20%. For major services, you pay half, they pay half. Orthodentra, you pay half, they pay half, up to $1500. This $1500 benefit reset every January.

Preventive services on dental are twice a year with a six month freeze. So, if you go today, you will have to wait six months before you can go again.

Vision: We are staying with VSP. We can get an exam, new glasses, both frame and lenses every 12 months or you can get contact lenses every 12 months. If you go to an in-network VSP provider, the co-pay is $10. Exam is covered 100%. If you need glasses, you pay $25 co-pay. Lenses are fully covered. Frames are not fully covered. You get a $150 dollar allowance. Some people prefer to go for high-end frames. VSP does not pay for that. They pay $150, and then you get a discount of 20%. Contact lenses you can get in lieu of frames and lenses $150 allowance. That is for in-network provider. You can go out of network such as Costco, Walmart, Walgreen, and instead of having a co-pay and a benefit allowance, you get reimbursed (you have to submit or file for reimbursement).

For vision, the allowance is not reset every January. It is reset every 12 month. If you get your glass today, you have to wait 12 months.

Life Insurance: 2 times your annual earning / salary. If your death is a result of an accident, any kind of accident, your benefit is double. Two plus two is four. If your annual salary is $100,000, and you die as a result of an accident, that is $400,000 left to the beneficiary of your choice. Unlike other type of insurance, unlike 401k, unlike when you buy insurance on your own, you have to leave it to your spouse, or you have to get their permission. With employer-pay life insurance, you do not have to leave it to your spouse. If you are going to leave your money to your children, and they are under 18, write “in trust for” the child. If you don’t write “in trust for” the child, they won’t get their money until they are 18. If you want them to get their money when they are 18, just put their names. If you want someone who care for your kids to get the money to care for them, you have to write “in trust for”. You don’t need a formal trust. The person just have to demonstrate that they are the guardian for the child. If you have a living trust, you can leave the money to your trust.

Short term disability and long term disability: these are coverages that pay you a monetary benefit if you are unable to work for defined period. Short term disability says that if you cannot work for a period after seven days, you’ll be paid 60% of your earning up to maximum benefit of $2308. If that short term disability turns into a long term disability, defined as 90 or more days, 60% of your money income up to $10,000 will be paid to you.

Employee Counseling services are counseling services that are available to you if you need some type of counseling, or child or elder care services.

Traveling assistance service: is available to you if you travel more than 100 miles away from your home.

How can I keep my medical cost low?

Rates are going up because of the way we utilize our insurance. We live in an area of most medically advanced region of the country. We have some of the best providers here in California. California is the most expensive state to buy health insurance. Texas is the close second. It is expensive to live here. It is expensive to get health insurance here. When Obama passed the Affordable Care Act, we heard “affordable”. Some people thought that really meant “affordable”. It does not. It did not really control cost. There are some cost-containment in there with certain things but it did not control cost. How can we be part of the solution? If thought a little bit about where we access our care, we might see a shift. For example, emergency room versus urgent care. Urgent care facilities are a lot cheaper compared to emergency room. If it is really a life threatening situation, by all mean, go to emergency room. Otherwise, if possible, go to urgent care facility.

Shop around. Seek out where the best and cheapest place to get your operation done. Cheapest is not always the smartest, but don’t get rip off. You should know, and evaluate your choice or decision after you gather and consider all the facts. Your healthcare provider should be able to tell you exactly how much it will cost you. Do not accept the delay answer “We’ll bill the insurance and they will let you know”. Your healthcare provider should be able to tell you exactly how much it will cost you. is an independent service where you can go in and put whatever you need to have done, and it will give you what is deemed reasonable in this area.

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