Can someone help me decode my health insurance plan? What does deductible mean? ?

I am looking into individual health insurance. Im using a major insurance company so I dont get screwed. Can you help me decode what all this means? and if what I'm paying is worth it? My rate is 162.46 a month. I dont know what deductable means and what these percentages mean! also what does no deductable mean? My plan is the standard option in the right hand column..THANK YOU!

http://www.ibx.com/health_plans/ppo/how_plan_works.html?content=/health_plans/ppo/benefits_summary/individual.html&origURL=/health_plans/individual/ppo.html

You might want to visit a local agent that works with BC and all the other major companies in your area. The agent can explain what you get and, more importantly, what you don't get with the plan and will be able to answer all of your questions. If you have any pre-existing conditions the agent can tell you what BC will do about those conditions. They will also be able to compare this plan to the other available plans to make sure you are not paying too much. There is no extra charge using an agent and the premium will still be $162.46.

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deductible is the amount you must pay out of your own pocket before the insurance kicks in. Some go by year and others by procedure. hope this helps.

Get to understand some basic knowledge of your confused area before taking suggestion from others is a great idea.Here http://www.healthinsurance-onlinetips.info is great
place to get start.

I use IBX too! They are a great company, very easy to work with (from a claims standpoint), but sticklers for procedure! Make sure you follow the plan requirements to the letter.

This is actually a pretty decent plan. I was going to suggest the standard option for you, btw, since it has an out of pocket maximum ($2000/$4000). More about that later. Is your premium for an individual or family? Through your employer or on your own? It's a decent rate if you have a family (more than 2) or have health issues. If you're very healthy, you might want to shop around, but again, it's not a bad rate.

Anything that lists a copay amount, no deductible-that means, you will pay that amount for each service, but you do not have to meet your annual deductible, which is $500/$1000. If you have a family, you will only have to meet the deductible on two of you! You have an unlimited lifetime maximum, which is great, because that means if you have a catastrophic illness/accident, you don't have to worry about your benefits running out.

If you see a preferred provider and have a claim that requires that you meet your deductible, like hospital, lab, etc, you will pay 20% of the charges, after the network discount and deductible. For instance, if you incur charges of $150, and the network discounts $25, and you have to pay $25 to meet your annual deductible, leaving an eligible amount of $100, your portion will be $20, plus the $25 deductible. Additionally, this charge will be applied to your out of pocket max.

You have a low out of pocket max, so if you are hospitalized for a couple of days to have your appendix removed, you will see charges processed like this: if you enter through the ER and are immediately hospitalized, the ER charges will be paid at 100% (your $40 copay will be waived bc you are admitted). Everything after that will be processed at 80% after you meet your $500 deductible. The first $500 will be yours to pay, as will the next $1500 (giving you your $2000 out of pocket for the year). After that, everything is paid in full. Do this in January, and you won't have to pay out of pocket for anything (except copays) for the rest of the year.

This is a great plan for chiropractic care, btw--is there a yearly max? Just be sure to use a preferred provider.

Any questions, just drop me a line.

Your deductible is what you have to pay out of pocket before insurance will start paying. Let's say your deductible is $300 a year for an individual...you are responsible for the 1st $300 of medical expenses before insurance starts paying on claims

The policy you are looking at breaks down like this: If you get pregnant for example, you go the DR once a month, and when there, pay for your Copay $15.00. When you go the the hospital to deliver, the Hospital bills Blue Cross $10,000 (for example) . Blue Cross (B/C), might allow $6,000, you would pay $500 of the $6,000 and your insurance would pay the remaining $5,500. Then, your $500.00 deductible for the calendar year would be met.

If you go to a hospital or Provider not in network, the Deductible is $1,000, so always try to find a provider that has a contract with Blue Cross, you can ask when you make an appt or get referred if the provider (hospital or company providing service) is contracted w/Blue Cross, (many medical companies are, because B/C is a huge insurance company.)

Let say, next year, you need a wheelchair, the "provider" (company you get a wheelchair from) would bill monthy about $100.00. Blue Cross would allow say, $60, you would pay that $60.00 month until $500.00 was met, then Blue cross would pay the rest, until the wheel chair purchase price is met.

Insurance policies are complicated, so if you want more info, I can try to help via email or phone, my email is
beckylou472@yahoo.com. There are just to many variables to policies and what services you may end up needing throughout your life. You never know Medical whatIssues may come up, but for a young woman, pregnancy seems the most likely, so I used that.
Good Luck!

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