How much will you pay out-of-pocket?
Deductible: This is the initial dollar amount you must pay before your insurance company begins paying for health services. In most cases, the higher the deductible, the lower your premium. However, do not choose a deductible so high that you cannot afford to pay it. The contract will dictate the specific amount you pay per year for your family. You must pay a deductible each year, which will vary depending on the number of people covered by the policy.
Coinsurance: Coinsurance is the share or percentage of covered expenses you must pay in addition to the deductible. For example, your policy may pay 80 percent of covered charges after you pay the deductible. You would then pay the remaining 20 percent as coinsurance.
Copayment: A copayment is a specified dollar amount you pay, as a subscriber to a managed care plan, for covered health care services. It is paid to the medical provider at the time the services are rendered.
Premium: The monthly or annual amount you will pay for your insurance policy.
Coordination of Benefits Provision: Even if you have more than one group policy, you cannot receive more benefits than your actual hospital and medical expenses.
Even if a husband and wife each have family coverage under separate group policies, they cannot collect on the same claim twice, even if they have paid two premiums.
Renewal and Premium Increase Provisions: These provisions determine the conditions under which you lose your eligibility, without a medical exam to prove you are in good health.
Why do companies raise premiums?
Insurance companies raise premiums when the cost of claims they must pay increases at a faster rate than expected. One main cause of premium increases is medical cost inflation, which measures how much more a particular procedure costs each year.
Medical Utilization, or the number of times doctors perform a procedure each year, can also cause premiums to increase.
Cost Shifting is also responsible for an increase in premiums. Cost shifting occurs when hospitals charge paying patients more money for their stay in the hospital. This offsets their cost of caring for non-paying or indigent patients.
New technologies and medical malpractice claims also increase the cost of health insurance.
What do your premiums pay for?
Premiums help pay policyholders' claims, and other expenses, such as producers' commissions, premium taxes, and administrative expenses.
How are premiums determined?
An insurance company considers many factors when setting premiums. Some of these include:
- Medical care costs
- Age of policyholder when policy is issued
- Current age
- Habits (such as smoking)
- Geographic area
Does my MOA-sponsored BCBSM health insurance policy cover me when I travel outside of the U.S.?
Yes, as long as the treating physician is licensed and the hospital is accredited. You will probably be required to pay when services are rendered. It is important to keep your receipts and send them to BCBSM along with a Subscriber Application for Payment form. BCBSM will reimburse you at the rate of exchange on the day services were performed.
Will BCBSM automatically add my newborn to my policy?
No. You must notify the MOA Insurance Administrator in writing within 30 days of the birth of your child. You can do so by completing a Subscriber Enrollment/Change of Status form.
In the event of my death can my spouse continue to be insured with MOA- sponsored BCBSM health insurance?
Yes, MOA offers Surviving Spouse coverage. Your spouse can continue to be insured as long as he or she doesn’t remarry or move out of the State of Michigan.
What is the difference between an individual health insurance policy and a group policy?
An individual policy covers you and your family. We have several plans available, including BCBSM Traditional and Community Blue. Some plans offer prescription drug and vision coverage. If you are looking for coverage for you and your office staff, we also offer group coverage. To see if you qualify for group benefits, please contact Julie Watson at 248-359-6489 ext 167.
I have an individual policy and I may be moving to another area in the state. Will my BCBSM rate change?
It may, because your premium is based on the area in which you live as well as your age. Your premium may stay the same, decrease or possibly increase. It is important to let us know in writing within 30 days of a change of address. You can do so by completing a Subscriber Enrollment/Change of Status form. We will notify you if there is any change in premium.
What is an Exchange?
An Exchange should be an efficient method of comparing and purchasing health insurance designed to provide individuals and small businesses access to health coverage.
The Patient Protection and Affordable Care Act (PPACA) has mandated that states create, establish, and administer Exchanges by January 1st, 2014 or a Federal Exchange will be implemented for the residents of that state. States can operate Exchanges in partnership with other states. The federal government will provide funding until 2015 to allow for flexibility.
What do Exchanges offer?
Exchanges will offer health insurance plans based on different “metal tiers” of benefit levels based upon their actuarial value; the average amount the insurer pays of covered benefits. A 90% actuarial value means that, on average, the insurer will pay 90% of the cost of benefits Member will pay the remaining 10% through deductibles, copays, or coinsurance.
Rating factors on the exchanges are limited to age, tobacco use, geography, and family status. Insurers cannot increase premiums based on pre-existing conditions or health issues.