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Author Topic: I know I should be happy that I have health insurance...
BannaOj
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The company I work for is part of a greater corporate group. It has gotten sold off at various times in recent histories to different other corporate interests. The reason is because we aren't really a "growth" sector. We make what we make, there will always be a constant supply and demand but not giant opportunities for expansion. We are already the largest mechanical seal manufacturer in the world.

So the latest corporation Smiths (a UK based company), decided that our health benefits system is merging into their health care system. I'm sure there are significant cost savings for doing so. And our costs particularly on prescriptions appear to be going up, not a huge surprise given how much you hear about rising health care costs everywhere.

The thing is, just looking at the initial data they presented during an hour and a half presentation today, it is going to take me probably 3-5 hours of sitting down and pouring over the options with a calculator in hand to figure out what the most cost effective plan is for me. And I have a college degree in Engineering. How in the world could someone who doesn't have the time because of children etc. be able to figure this out in the short amount of time we have to decide? (Dec 1 is the deadline)

The thing that is always the sorest point for me is that I currently have to spend $160 a year to stay on birth control and *not* get pregnant, when me not having dependent children on the benefits plan, clearly minimizes the company's out of pocket costs. Now, my particular birth control, Yasmin, is a brand name, because of the form of progesterone they use called drospirinone. I formerly had a maximum cost of $40 every three months. Now it appears the minimum cost is $40 and the maximum could be up to $100.

So I *may* need to budget up to $400/year just for birth control. Now, there is a flexible spending account that I can put money into and use pre-tax dollars to pay for this. However, the question is always how much money do you put in? I asked the prescription guy how I was supposed to estimate this cost (realizing that market values fluctuate), and he said well it will be on the website after January 1st. That does me a lot of good for my December 1st deadline!

Now I am greatful that I do work for a company that offers health insurance and benefits. But I sure wish the system could be simplified somehow.

AJ

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katharina
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I think we just had out Benefits Season too, but nothing's changed on my end so I didn't pay much attention.

I hate, HATE the insurance company and that blasted symptom. I have some lingering effects from my accident in Germany, and request for claim was sent to company. They lost it. Twice. SEVEN months later I get an aswer back: "No." I want to kick the wall.

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Bokonon
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FSAs, it seems to me, are bad things, as currently set up. I've heard horror stories where if you get laid off, you have 30 days to use it all, or your former company gets to keep the cash. That's right, the company who put you out of work, gets to keep some of your wages, just because that's the way it is.

-Bok

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AmkaProblemka
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Gah, your company doesn't have to be sold off to change insurance.

We changed insurances last year. What happens when you have kids is that you send them to the boob tube and tell your husband to go get take-out while you pour over all the documents. He does all the bills, but when it comes to any paperwork or legal stuff, I take care of that.

As far as what to put in your flexible spending account, I would assume the price will go up 20% over the next year, and if it doesn't, use the extra towards a new pair of glasses or there are several over the counter drugs that you can stock up on. You can also use the flex plan for co-pays and such. I have to be happy with the new flex plan they offered us this year: it turns over to the next year. Still, we've never needed that. <sigh>

Last year, we figured 1000 in the flex plan would be enough, until our kids went to the dentist.

This year we get to pay for labor/delivery and braces. Woohoo. Braces are very poorly covered, 1000 lifetime. Our daughter's is going to cost about 5000.

[ November 10, 2004, 03:25 PM: Message edited by: AmkaProblemka ]

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Intelligence3
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quote:
probably 3-5 hours of sitting down and pouring over the options with a calculator
Respectfully, it's poring. As in going right down to the pores*.

This message has been brought to you by the nitpick office.

* This is not the etymology, but a mnemonic device.

[ November 10, 2004, 03:30 PM: Message edited by: Intelligence3 ]

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ludosti
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I hear you AJ. I spend $30 a month on birth control - not covered by my insurance (but is the only kind we've found that doesn't make my cholesterol dangerously high).
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katharina
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As one Grammar Nazi retires, another arises to take its place.

Welcome, I3.

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Xaposert
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quote:
The thing that is always the sorest point for me is that I currently have to spend $160 a year to stay on birth control and *not* get pregnant
You have to? I don't think so... I know of a method of avoiding pregnancy that costs nothing whatsoever!

Well, nothing monetary. [Wink]

[ November 10, 2004, 03:36 PM: Message edited by: Xaposert ]

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BannaOj
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You know it it didn't look like it was right when I typed it, and I changed it to poring and then changed it back before I posted...

AJ

[ November 10, 2004, 03:37 PM: Message edited by: BannaOj ]

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BannaOj
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Xap I know you know that I'm not married, but in this case it makes no difference. No one reasonably expects a married couple to abstain even if they wish to remain childless.

They showed us a chart today, the company subsidizes roughly 70% of the cost of the plan. My plan costs me $30/week for me alone, and $90/week if I had a family. Therefore, the company is paying $70/week for me without children and $300/week for me with children. Pretty simple math. It is to the company's financial benefit if I don't have children. Also, not having children the worst thing I ever have a family emergency over and have to take time off of work for, is dog diarhea, which isn't nearly as bad in lost manhours as a small child with the flu.

I'm not saying a company should be anti-family, but why not reward the people that cost them less?

AJ

[ November 10, 2004, 03:46 PM: Message edited by: BannaOj ]

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rubble
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AJ,

Commiserations on your trial by option health insurance plan.

I thought you said you were an engineer. I didn’t realize you made children’s toys for a living. [Wink]
quote:
We are already the largest mechanical seal manufacturer in the world.
Best of luck! [Smile]
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msquared
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You know that my wife and I have used the Rythem method for the past 10 years and have never gotten pregnant. My wife hated being on the pill, it basically turned off her libido. I hated that as well.

msquared

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AmkaProblemka
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It isn't really having the family that ups the insurance so much. At $90 a week, that works out to $360 a month. For a healthy couple with healthy kids, we were able to get an insurance plan that cost this all by ourselves, and we actually declined our insurance benefits with the company that made us pay $400 a month for insurance 'benefits', and were able to find pretty much the same plan for $300 a month.

What you, and other families, are paying for is the poor health of co-workers. Some of that is unavoidable, but where you can go private into a pool of non-smokers/non-obese people with no health problems, you can sometimes get a much better deal with insurance. Check it out before your deadline. You may even be able to shop around and find something that pays for birth control. I'm often suprised at insurance companies not paying for birth control either, since it basically means that you won't get pregnant and that costs a lot more than a pregnancy.

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katharina
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quote:
the largest mechanical seal manufacturer
I love the mental image. [Smile]
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jeniwren
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m2, what do they call women who use the rhythm method?

Mothers. [Smile]

It worked pretty well for me for the first 4 years of my first marriage. But the one time it didn't is named Christian. He's 11 now. [Smile]

I'm a great believer in vasectomies now that we know we don't want any more kids. It wasn't covered under insurance, but it's very nice to not even have to think about birth control anymore. Well worth the $600.

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Sara Sasse
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Sometimes people find an underlying infertility issue after they stop any type of contraceptive method (including rhythm) and try to get pregnant. It's so hard to assess any means just from anecdotes, which is why generalized data helps.

But I'm glad it works for you, msquared! [Smile] Recently I have been quite glad that my chosen method works for me. I would have been under the floor with depression if I had any additional responsibilities.

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msquared
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Except that we have two kids, 13 and 10.

msquared

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Sara Sasse
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jeniwren, I'm a big believer in vasectomies, too. [Wink]

And AJ, I agree completely -- figuring out which plan works best for you can be murder, even if you know the language. [Frown]

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Sara Sasse
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That's great, msquared! But that doesn't rule out secondary infertility at all. Just because you were fertile 10 yrs ago doesn't mean you are still fertile as a couple now.

The odds are still better than for someone who never conceived, true, but secondary infertility is the fastest increasing subset of infertility now.

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BannaOj
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The reason why I'm on the particular pill I am on, Yasmin is because it works particularly well for PCOS. Not for birth control. I would be using other, cheaper prescribable forms of birth control if it was for birth control alone. (And preferably one that I didn't take by mouth daily...) Yasmin costs more because it is the only drug of its kind out there that uses drospirinone as the form of progesterone. There aren't any substitutes (that I am aware of).

AJ

[ November 10, 2004, 04:16 PM: Message edited by: BannaOj ]

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advice for robots
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<English Nazi>

If you study a document intently, you pore over it. You don't pour over it unless you're trying to get it wet. [Razz]

</English Nazi>

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TheTick
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:: pours over afr ::
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Xaposert
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"Pour over" makes more sense though.... When you look over a document completely, you do "pour" over the whole thing like water.

Even if that wasn't the traditional expression, we should make it "pour" instead.

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dread pirate romany
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AJ, if you are on yasmin for reasons in addition to birth control, could you get it covered under the PCOS issue?

(And off topic, my husband gets snipped in 44 1/2 hours. Yay!)

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advice for robots
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*Towels off hair*

But you also examine every pore of the document, so to speak.

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Xaposert
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quote:
Xap I know you know that I'm not married, but in this case it makes no difference. No one reasonably expects a married couple to abstain even if they wish to remain childless.
No one does? I do, and I know for a fact there are lots of people way more extreme than me on the issue. So some people definitely do. (For one thing, you risk having to have an abortion if you choose to have sex without intention to have a baby... among other big negatives.)

More importantly, though, if you choose to have sex, you shouldn't expect your employer to pay for it. It's a luxury.

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Sara Sasse
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Interestingly, the ADA covers sexuality as an "activity of daily living": i.e., one is disabled if one does not have the physical ability to engage in it, given the option.

So, by governmental legal definition, it is not a luxury, but a fundamental part of what it is to be human.

Sounds about right to me.

[ November 10, 2004, 04:30 PM: Message edited by: Sara Sasse ]

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AmkaProblemka
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Uhm, I don't think sex is a luxury. I think it is a very important and necessary part of a happy marriage.
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BannaOj
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[ROFL] I think you can rest assured Tres that I've just called you unreasonable.

quote:
quote:

Xap I know you know that I'm not married, but in this case it makes no difference. No one reasonably expects a married couple to abstain even if they wish to remain childless.

No one does? I do, and I know for a fact there are lots of people way more extreme than me on the issue. So some people definitely do. (For one thing, you risk having to have an abortion if you choose to have sex without intention to have a baby... among other big negatives.)

More importantly, though, if you choose to have sex, you shouldn't expect your employer to pay for it. It's a luxury.

Hmm maybe we should tell every species in the animal kingdom to stop procreating, they don't have the luxury of doing it because of the possible offspring involved. [Roll Eyes] Lol, if even most of the people in the United States didn't believe it was a basic right for their animals, we wouldn't have the animal shelter overpopulation problems we do.

****
Also romany it doesn't matter *what* kind of medical condition the birth control is for. PCOS, pregnancy prevention, it makes no difference. A prescription drug is a prescription drug is a prescription drug, in the eyes of The Plan.

AJ

[ November 10, 2004, 04:37 PM: Message edited by: BannaOj ]

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Xaposert
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Animals go around killing other animals freely, too. Does that mean murder is okay for humans?

The are very good reasonable reasons to conclude sex without the willingness to have a baby is wrong:
1. It causes abortions - a.k.a. the potential murder of unborn children.
2. It causes children to be born into very bad conditions - to people who might be unprepared or incapable of raising kids.
3. It acts as a drug: Sex tends to disrupt relationships and lives in an unhealthy fashion, when done so outside of a very stable relationship.
4. It harms society in general. It promotes the idea that sex is principly an instrument for fun and pleasure, which results in more of the above three.

No company should be under an obligation to pay for that.

[ November 10, 2004, 04:51 PM: Message edited by: Xaposert ]

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jeniwren
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How would you explain, then, that many insurance companies cover Viagra on their prescription plans?
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BannaOj
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As I said before I think you being completely unreasonable. By your logic above, same sex relationships are the healthiest relationships to have sex in, since there is no possible offspring.

Also since probabilities are multiplicative, in a heterosexual relationship, if you use several methods of birth control in conjunction with each other. (Oral contraceptive, spermicide and a condom together for instance) It is possible to reduce the probability of pregnancy to 0.000001% Give me a break. People who are having responsible sex aren't the ones having abortions.

As far as my own personal situation goes, because of the PCOS it would likely be medically indicated for me to stay on the pill even if my significant other got a vasectomy or if I got a tubal ligation (which I plan to if I hit 35 and still don't want children).

AJ

[ November 10, 2004, 05:02 PM: Message edited by: BannaOj ]

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BannaOj
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Jeni, maybe they only prescribe Viagra to the married people who are fiscally responsible enough to have children... [Roll Eyes]

AJ

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advice for robots
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Tres, IMO, some of the principle fun and pleasure of having kids is trying to make them. [Smile]

I'm a believer in birth control. We want to have kids, but with my wife's medication, we have to very carefully control when it is possible for her to get pregnant. She has to be off her medication for the first trimester for the baby's safety. If she got pregnant "by mistake," the baby could end up with birth defects, which would be devastating. Using birth control correctly, there is a much lower chance of that happening.

And I firmly believe that a good, healthy sex life is a huge contributor to marriage, with or without the intent to have kids. I mean, sex is enjoyable (and just as needed!) during most of pregnancy as well, and then procreation is kind of a moot point. [Smile]

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Xaposert
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quote:
How would you explain, then, that many insurance companies cover Viagra on their prescription plans?
Well, companies are (unfortunately) allowed to disagree with me. [Smile]

quote:
By your logic above, same sex relationships are the healthiest relationships to have sex in, since there is no possible offspring.
I would agree that they are safer than premarital sex.
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jeniwren
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My eyes roll with you, AJ. [Smile]

I've often thought it was stupid when insurance company prescription plans didn't cover birth control. Even worse that it would cover Viagra.

I'm sure there's a business reason for it, and that the reason is probably spelled M-O-N-E-Y.

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BannaOj
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Tres I'm confused. Does your definition of "premarital sex" mean strictly "heterosexual penis to vagina intercourse".

(And I don't want to argue with you over semantics I simply want to know how you personally are using the words "premarital sex")

AJ

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BannaOj
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Jeni, it isn't just money though, cause the numbers say, that they will be paying considerably more if a woman that they employ has a child. I think it probably has more to do unfortunately with residual chauvinistic bias in our society.

It would be interesting to see how much one would have to pay for monthly prescriptions of viagra under this plan.... going to look it up if I can..

AJ

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TomDavidson
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Maybe Xap's having the wrong kind of sex.
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Slim Shady
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Or none at all? [Wink] [Evil Laugh] [Evil]
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jeniwren
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AJ, I don't know how money comes into play on this issue...I just subscribe to Heinlein's theory that the answer to every question that starts with "Why don't they..." is Money. [Smile]
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BannaOj
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[ROFL]
The Plan limits you to 8 Viagra tablets in any 30 day period (interestingly it doesn't matter whether the dosage is 25mg or 100mg.) Viagra is a non-preferred name brand drug so it appears that it would be a $45 minumum co-pay per month or $90 minimum for a three months mail in supply.

AJ

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Dagonee
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quote:
Jeni, it isn't just money though, cause the numbers say, that they will be paying considerably more if a woman that they employ has a child. I think it probably has more to do unfortunately with residual chauvinistic bias in our society.

It would be interesting to see how much one would have to pay for monthly prescriptions of viagra under this plan.... going to look it up if I can..

Their thinking might be that a woman with an income such as yours is unlikely to forgo birth control because of price. The incentive is there for the woman to avoid pregnancy if she doesn't want a child.

As to price, I have to pay ~$120 per year for the prescription I have to take daily. If they weren't available generically, I'd have to pay either $240 or $360. It's possible your new plan just has crappy prescription coverage like mine. [Smile] I'll be interested to see what you come up with for the price of Viagra. It'd be good to compare brand-name and generic prices if they're both available.

Dagonee

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BannaOj
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Dagonee the problem with the "income" argument is that I'm probably in the top 30% as far as salary goes for women in this company. What about the 70% stuck with the same crappy prescription plan below me? I'm enough of a socialist that I would actually be happier if it was scaled so that the lower paid people got better benefits and I had to pay more for mine.

AJ

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Dagonee
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I'm not talking justice - I'm talking monetary incentive for the insurance company. [Smile]

Given that some birth control is available relatively cheaply, the extra incentivizing effect to use birth control from increasing the subsidy might be minimal.

If there's one thing insurance companies are good at, it's figuring stuff like that out.

Dagonee

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BannaOj
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True, and this time we can't even blame it on lawyers... but accountants!

[Wink]
AJ

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Dagonee
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Actuaries, actually.

They make accountants look like party animals.

[ November 10, 2004, 05:33 PM: Message edited by: Dagonee ]

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bCurt
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quote:
At $90 a week, that works out to $360 a month. For a healthy couple with healthy kids, we were able to get an insurance plan that cost this all by ourselves, and we actually declined our insurance benefits with the company that made us pay $400 a month for insurance 'benefits', and were able to find pretty much the same plan for $300 a month.

What you, and other families, are paying for is the poor health of co-workers. Some of that is unavoidable, but where you can go private into a pool of non-smokers/non-obese people with no health problems, you can sometimes get a much better deal with insurance. Check it out before your deadline.

Shopping for individual coverage may be worth it but be sure to compare coverage very very carefully. Most often group coverage is more comprehensive and has lower out-of-pocket expenses. Watch for limitations and exclusions on an individual policy. Also, check out the insurance company carefully to be sure they aren't one of those companies that bump up your premiums big time each year (some sell it low and bump it high). If possible, it is nice to talk to someone who has had coverage with that insurance company for a couple of years.

If you think going over your company's plan options is a pain, you would truly enjoy going over a comparison of individual policies to your group plan. Individual health insurance policies are different from company to company and you also want to shop for good company.

quote:
You may even be able to shop around and find something that pays for birth control. I'm often suprised at insurance companies not paying for birth control either, since it basically means that you won't get pregnant and that costs a lot more than a pregnancy.
It is surprising how many do not cover birth control. In some states, however, they don't cover the consequences with individual policies (like in Texas where one or two insurance companies offer maternity coverage with their individual health policies and charge a chunk for it).

It is too bad your company doesn't offer an HRA (Health Reimbursement Account). Similar to an FSA but provides rollover of funds from year to year and is portable.

[ November 10, 2004, 05:55 PM: Message edited by: bCurt ]

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BannaOj
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They are actually talking about the HRA but didn't implement it this year. An interesting bit with this new system, is that our plan administrator negotiates discounts for LASIK outside of any vision plan.

There is a separate vision plan but the new one is even worse than the old one. I'm getting my new 6-month supply of contacts in December, filing my claim under the old plan, and simply paying into the FSA from now on to afford my glasses and contacts. For what I had before, it wasn't much more than a savings account anyway.

AJ

[ November 10, 2004, 06:01 PM: Message edited by: BannaOj ]

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Xaposert
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quote:
Tres I'm confused. Does your definition of "premarital sex" mean strictly "heterosexual penis to vagina intercourse".
No. But that's the sort that risks abortion, of course. The others are dangerous in less direct ways (like #3 and #4 that I listed).

The others also don't need the sort of birth control you were complaining about not getting.
quote:
Or none at all?
Well, duh! I could hardly be making this point if I were unmarried and having sex. I'm not THAT much a hypocrite.
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