My questions - while insurance & health related, go beyond simply "health insurance". If this is not allowed I will remove it. Also, any tips on other places to post this would be appreciated. I looked at "findareddit" and couldnt find a more general "benefits" channel.
Could you folks comment on some of the benefits selections I've made before my final submission? A lot of what is being offered seems duplicative, or not applicable to me. Still, there are supplemental options and I'm not sure where one coverage ends and another coverage picks up.
A bit about me
mid 30's professional
pretty good shape
I enjoy the gym
don't smoke & only drink very occasionally
carrying an extra 5 pounds on me currently
I'm adventuresome (ski, backpack bike) and want to be covered in case I break a leg skiing or get hit while riding my bike. I am single and have no children.
While I am fairly healthy, I've not been to a doctor for a long time, and currently I have a lower deductible selected this year as I have some "deferred maintenance" I'd like to get checked out.
My current health insurance - more info - since I have some deferred maintenance I'm considering a lower deductible option for this year. What do you all think?
FSA - I set it for $400 for the year. I figure it will mostly be copay's, and other assorted costs/fees. Should I do more/less?
Basic Life and AD&D - got this for the "Dismemberment" portion - in case I'm ever injured. also it is free.
Supplemental Life and AD&D - $13/year for $50K benefit seemed like a good deal. But I don't understand what it covers
You have only screenshot one plan, so no real room for comparison.
For many people, their needs exist on a bell curve of total cost. I.e. they want the plan with the lowest combination of both premiums (paycheck) and out-or-pocket maximums, as it covers both a healthy year and a worst case scenario the cheapest.
HDHP plans often fit this bill, plus you can often put money in an HSA to reduce your pre-tax income and spend on healthcare-related costs tax free even after you leave the job or retire.
Not sure if your PPO plan has this, as you did not include the blue Summary of Benefits and Coverage (SBC) table, but Copays can be exempt from your deductible.
I.e. they won't count towards it, nor will they stop when you reach it with other claims (e.g. labs, procedures, imaging).
That is, you might pay for $3,000 worth of $25 office visits, and probably copay medications, instead of maybe 4-5 visits (which would hit $750/deductible) and then 10% Coinsurance on everything.
Be advised that unlike an HSA, which you can only get with qualifying plans, an FSA...
Expires at the end of every year, "use it or lose it," except for an amount allowed by your employer (could be $0 or up to $500).
Belongs to your employer, so you do not keep it if you leave the job.
Thus, unless you can think of FSA-qualifying expenses to burn through that, do NOT put too much in as you cannot change the amount during the year (like HSAs).
Also, FSAs have stricter rules and regular auditing of what you can claim yourself. If the FSA company disagrees, you can be forced to reimburse them as well as paying income tax and penalties.
The screenshots you attached only seem to cover the AD&D supplemental portion, i.e. you didn't take out supplemental life. Supplemental meaning more than what your employer provides to you at no cost.
AD&D covers loss of limbs (many situations) as well as death that was caused by an accident (not you or someone else's direct action).
That's why its cheap, and not subject to underwriting, as its far less likely to happen.
Life Insurance, which you didn't take out beyond what the employer pays for, covers other causes of death (old age, illness, other people's actions, etc.).
It is underwritten, so unless you are a new employee they will send you a questionnaire (called Evidence of Insurability) and a medical records release to contact any primary doctor or specialist you saw within the last 7-10 years.
This also applies if you change the amount or coverage later.
DO NOT LIE on that form, as there is a massive database (called MIB/Medical Information Bureau) that could easily disprove that and get you convicted of fraud. It doesn't contain health records, but previous insurances you had or applied for so the new company can track them down.
Disability insurance replaces a percentage (e.g. 50%) of your income if you are unable to work for a covered reason for a given period of time.
The lengths of time you need to be disabled, and how long the coverage lasts, will be explained in the "more details" section of each plan or the attached brochures. As an example:
STD: Latter of when you run out of leave time (PTO, FMLA, UTO, etc.) or 2-3 months, though between 18 and 60 months. Can also have a total cap on how much they pay.
LTD: Once STD expires, or at least 18-24 months, though an amount of years (e.g. 5, 10, 15, etc.) or age (e.g. 65, 85, etc.) you specify and purchase.
As with Life Insurance, you will be subject to underwriting if you are signing up or changing your coverage outside of being a brand new employee.
Accident insurance, along with Hospital and Critical Illness, are Fixed Indemnity plans. That is, they pay you (not the doctor/hospital) a listed amount per category (e.g. $400/day for imaging) when a covered event occurs. E.g. breaking your wrist and needing X-rays or burning your hand and needing to spend the day in an expensive trauma ward.
The brochures your company has access to will give examples of what the payments are, and if they differ between various Accident plans (e.g. a High or Low option), along with the maximums the plan will pay per year.
You might also be able to recoup the amount you paid per paycheck, or some amount per year, by completing health checkups and other activities (e.g. physical, heart EKG, etc.). Not all employers offer this, though.
Many Accident plans have a list of accident types they cover (e.g. ~150 at my employer) as well as exclusions where they won't pay anything (e.g. known risky situations, when other (e.g. auto, workmans comp) insurers would pay, cheaper treatments possible, etc.).
Hospital Indemnity coverage varies WILDLY between employers in terms of when your hospital visit will be covered and for what amounts and reasons.
E.g. your employer's plan might not cover any hospitalization related to a pre-existing condition, regardless of how old or infrequent, or anything that is an elective procedure, or both.
As with Accident Insurance, there will be a list of categories and what they pay for each per day or hospitalization. It doesn't change based on what you are in the hospital for (again e.g. $400/imaging regardless of it being an $80 chest X-Ray or $3k MRI).
Read the brochure before you consider this one, as it can sometimes be cheaper to skip it and put the money in your savings if you can meet the health insurance deductible and related costs.
Critical Illness, which you didn't list, is a lump sum payment (e.g. $10-30k) if you didn't have an expensive condition (e.g. cancer, stroke, heart attack, etc.) before you were first covered by the plan and then had it.
Some plans include recurrence clauses, which will pay a certain % if you return to a stable or healthy condition while still covered, and then the condition re-occurs. E.g. a second stroke 5 years later.
Given the payout and low price, often in between the Accident Plan and the Hospital one, they will want to investigate any precursors before they pay a claim...new employee or not.
