Buy Up Ppo

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buy up ppo

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Once a year in October, employees may change from one plan to another or add dependents. During the year new dependents may be added within 31 days of marriage, birth, adoption or formation of domestic partnership, and children of domestic partners. After 31 days, the dependent cannot be added until the next open enrollment.

Product availability may vary by location and plan type and is subject to change. All health insurance policies and health benefit plans contain exclusions and limitations. For costs and details of coverage, review your plan documents or contact a Cigna representative.

My employer is offering a buy-up plan for health insurance next year, and I'm wondering if it's worth the added cost. I typically see my primary doctor three to four times per year and also see a few different specialists. I take three prescription medications on a regular basis and am considering elective bariatric surgery. Is a buy-up option right for me? What should I take into consideration?

This is a good question for this time of year, during the open enrollment period that sees companies offering new health insurance options for employees. As with most decisions about your health care, you should make this one with careful consideration.

First, what is a buy-up plan? Many companies offer employees a base health insurance plan, with basic coverage and the company paying a portion (or even all) of the costs. But some companies also offer plans that allow employees to obtain greater coverage at an increased premium -- that is, to buy up to a higher level of insurance. In exchange for higher monthly premiums, these plans may include lower out-of-pocket expenses when you access care, such as lower deductibles and copays, and greater freedom to choose providers out of network.

Step 1. Take stock of your health needs and medical treatments over the last year to estimate the services you'll need in 2015. If you think you'll need less care in the coming year, you probably don't need to consider the more expensive buy-up plan and can extend your current coverage.

However, if you aren't sure, start by making a list of your 2014 health needs and itemize your out-of-pocket expenses. If you used a health savings account or flexible spending account, refer to your statement to build your list of health expenses. Don't forget to include the cost of elective procedures, as well as your prescriptions, specialist appointments and regular doctor visits.

Consider how your health needs will change over the coming year. If you do pursue an elective bariatric procedure, know that it requires medical care before and after surgery. You will visit a doctor many more than three or four times in the year of your surgery and will require additional prescription drugs. These costs can add up.

Preventive care is free under the Affordable Care Act, and routine screens like mammograms and colorectal cancer screens will not come at an added cost to you so long as you meet age qualifications. But if you know you will need additional, non-preventive care or treatments in 2015 -- like bariatric surgery -- you should consider the buy-up plan.

Step 2. Evaluate the physician network size of each plan -- that is, check out the number and quality of physicians included under each one. When you buy insurance, you are in many ways buying discounted access to a network of physicians. Thus, you should consider doctors you'll need to see in the year ahead and the quality of doctors available through each plan. The simplest way is to ask the insurance company how many doctors are available across the specialties you need. If you're considering bariatric care, now is the time to research doctors in your area and see if your preferred doctors are included in your insurance plan. Seeing an out-of-network doctor can drive up your costs by thousands of dollars. If the buy-up plan does not include the doctors you need or improve the quality of doctors in your network, it may not make sense to pay extra for the buy-up plan.

Step 3. Make sure you understand what's covered -- and what's not covered -- in each plan. It's especially important if you are considering an elective procedure like bariatric surgery that you know what's covered under both plans. States treat bariatric benefits differently, and different plans have different policies on top of that. Though buy-up options often cover more medical services, they still might exclude some elective surgeries completely.

Here are a few ways to find the information you'll need. Get the plan documents or call the insurance company to understand what's included. For your prescriptions, look up the plans' drug formularies to see which of your prescriptions are covered. But don't stop there: Look up the tier of coverage for your drugs under each plan and confirm the copay assigned to that coverage tier. A more generous plan may cover your prescription drugs with a lower copay. Take the buy-up option if it covers care you need that your standard plan doesn't include.

Step 4. Examine the plans offered by your employer and calculate how much under each one you would owe in monthly premiums. Also look up the out-of-pocket expenses you'll incur, including copays, coinsurance and any deductibles. There should be an inverse relationship between your monthly premiums and your out-of-pocket expenses: The higher your premium, the less your need to spend for doctor visits and prescriptions. You also want to know you've purchased enough insurance so that you needn't worry about health expenses. If you need more care in 2015 and predict your extra premium expenses will offset your extra costs, choosing a buy-up plan could be a good decision.

Choices made this year during open enrollment will determine your coverage only in 2015. Though it's important to make the right decision now, you can adjust your policy again next year if your needs change or your employer offers a better choice.

The Affordable Care Act means health insurance plans for individuals and families have more in common, like metal tiers and essential health benefits. But you still have some decisions to make when finding the right plan for you and your family.

A good way to start is to think about how much you use your insurance. If you go to the doctor a lot, you may want a plan with higher monthly payments but lower out-of-pocket costs. It makes your medical expenses more predictable.

If you're healthy and rarely go to the doctor, you might want a plan with lower monthly payments. But lower-priced plans have higher out-of-pocket costs. That means you'll pay more up front when you need medical care.

Everyone's life is different. But no one is immune to illness and injury. That's why there's health insurance. A good approach is to get a plan that balances the lowest out-of-pocket expenses with a monthly payment you can afford. That could be the right plan for you.

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Last year, the average premium for health care insurance at mid-size and large companies increased 4.4 percent, up from 3.3 percent the prior year. That nets out to about $10,717 per participant, who in turn contributed an average $2,487 toward insurance premiums and spent an additional $2,295 in out-of-pocket costs.

According to a corporate health and benefits consultant, this year increases are expected to rise 5.5 percent (after plan design changes and vendor negotiations). This percentage increase nets out to an average of $11,304 per worker. Participants are expected to contribute $2,664 toward premiums and $2,487 in out-of-pocket costs, for an average total increase of $369 for workers and $218 for employers in 2015.

By year end, the average worker's share of health care costs will have increased by more than 52 percent, or $1,762, since 2010. While transferring the high cost of benefits to workers has been a popular strategy in recent years, clearly employers need to devise more effective ways to relieve this increasing financial burden on members. As such, many organizations and labor unions are working to create a mix of traditional and non-traditional tactics to rein in benefit costs.

Contribution StrategyEmployers should be mindful of the impact of uncertainty on their employees. In other words, changing your plan design and subsequent shared costs each year can lead to more member anxiety than higher but fixed contributions each year. An organization should strive to develop a long-term sustainable contribution strategy for its overall group benefits program.

The Patient Protection and Affordable Care Act (PPACA) required employers to eliminate varying plan levels based upon organizational hierarchy. In response, employers today are trending toward a defined contribution strategy, many in conjunction with the private insurance exchanges. The employer contributes a set amount of dollars and the employee chooses what level of insurance to purchase with those dollars. This may include a contribution level appropriate to cover minimum required healthcare benefits, with the option for members to "buy-up" to a higher level (silver, gold or platinum), purchase ancillary coverages, such as dental or vision, or increase life or disability insurance options.

Buy-up CoverageSome employers offer members a base health insurance plan and may even pay for the entire cost of minimum essential coverage. Workers can then use additional fund credits to "upsize" for richer coverage at an increased premium that may offer lower deductibles, copays, and the ability to visit out-of-network providers. 041b061a72