![[personal profile]](https://www.dreamwidth.org/img/silk/identity/user.png){kind=small}
Obamacare: what it is, what it's not
.
This year, my company outsourced the benefits enrollment process to a third-party vendor. Through this other vendor, the health plan options are divided into bronze, silver, gold, and platinum levels (similar to what is shown on panel 9 at the above link - I didn't realize this was similar to the exchanges).
Each metallic level has a few options to choose from - 3 or 4 insurers, each with different premiums. From what I could tell, though, the deductibles and coverage amounts within each level are basically the same, regardless which insurer you choose. The premiums vary a lot though.
An interesting thing I found out is that my company (now as well as in past years) self-insures its medical benefits. This means that it pays all claims itself, even though administration of the claims is handled via insurance companies.
So... my company pays the actual medical claims/costs. The insurance companies are being paid only to administer the plans. This seems to indicate to me, that the different premiums charged for each insurer's plan must reflect a difference in administrative costs (and/or profit margins).
.
This year, my company outsourced the benefits enrollment process to a third-party vendor. Through this other vendor, the health plan options are divided into bronze, silver, gold, and platinum levels (similar to what is shown on panel 9 at the above link - I didn't realize this was similar to the exchanges).
Each metallic level has a few options to choose from - 3 or 4 insurers, each with different premiums. From what I could tell, though, the deductibles and coverage amounts within each level are basically the same, regardless which insurer you choose. The premiums vary a lot though.
An interesting thing I found out is that my company (now as well as in past years) self-insures its medical benefits. This means that it pays all claims itself, even though administration of the claims is handled via insurance companies.
So... my company pays the actual medical claims/costs. The insurance companies are being paid only to administer the plans. This seems to indicate to me, that the different premiums charged for each insurer's plan must reflect a difference in administrative costs (and/or profit margins).
Self Insure
Date: 2014-11-03 04:09 pm (UTC)From: (Anonymous)HealthInsurance Stuff
Date: 2014-11-23 11:03 pm (UTC)From: (Anonymous)Re: HealthInsurance Stuff
Date: 2014-11-23 11:48 pm (UTC)From:Medical providers usually charge different prices depending if you have insurance or not. The insurance companies negotiate better/cheaper prices than non-insured people get. So a non-insured person might be charged $1000 for the same procedure that an insured person would be charged $500 for. The $500 is what the insurance company calls the "allowable charge" - any charges over that amount do not need to be paid, based what they've negotiated with the providers.
When you're insured, you pay premiums to the insurance company, as well as paying deductible and co-payment amounts directly to the medical providers. The insurance company pays the providers the remainder of the charges, using money from all the premiums they have collected.
When a company provides health insurance to its employees, it generally pays a part of employees' premiums as part of their benefits package. For example, they may pay half the premium. So if you are insured through your company, you may pay $50/month in premiums, whereas if you were self-insured, you'd be paying $100 a month.
If a company is self-insured, it still contracts with an insurance company. So you still get the negotiated rates, and you still pay the same deductibles and co-payments. I suppose premiums go to the employer, rather than the insurance company. The employer must pay some negotiated amount to the insurance company for their administrative costs.
Rather than the insurance company paying the remainder of the costs from the collected premiums, the employer pays those costs.