25 May 2024 Group Benefits, Insurance Discounts It is not until one of the boys crashes his bicycle and there are complicated broken bones that those would come into account. The PCP ($5 office visit) refers the broken boy to a specialist ($50 office visit), x-rays are needed and some physical therapy. Now, those services require the coinsurance and start adding up to the maximums. The boy had only spent $10 towards his deductible prior to the bike crash. The first $1,490 of the bike crash would fulfill the deductible. At that time the copay percentages would kick in. For simplicity’s sake, let us say the x-ray costs $1,435. Now, the annual deductible is fulfilled (three office visits of $5, one specialist of $50 and x-ray of $1,435). Insurance will now cover all but the coinsurance, until the maximum out-of-pocket is reached. The coinsurance rate is 20% on our plan. Casting the broken leg costs $2,000. Insurance covers 80% or $1,600. The 20% coinsurance is $400 and applies towards the out-of-pocket maximum of $6,000. Out-of-pocket now sits at $1,900 for the broken boy for the year. Insurance will pay 80% of anything else for little Jimmy, until another $20,500 is spent. Twenty percent of $20,500 would produce the remaining $4,100 towards the maximum out of pocket. At that point, insurance will pay 100% of the costs. The example is complicated. What it illustrates is that a normal family will have to have extraordinary medical needs in a year to reach deductibles and maximum out-of-pocket levels. Families only utilizing primary care office visits will only pay the copay and not reach a deductible. All but three of the AOL Health Benefits plans have 80% coinsurance after the deductible is reached. The main difference in AOL Health plans are the deductible levels and out-of-pocket maximums. Beginning in 2024, the new law covering office visits will make most families’ yearly doctor visits less expensive. All but high deductible plans will have the three $5 PCP visits. This really only reduces a family’s cost by $135 (maximum copay of $50 each for three visits reduced to $5 each) per member. t
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