Healthcare System
My current healthcare plan is through Aetna via my husband's work. It is through a company, so the cost is drastically less than a private plan.
Husband's employer
Out of Pocket Costs:
In Network Co-Pay: $
In Network Deductible: $500
Out of Network Deductible: $1,000
Percentage of Coverage: 100% after deductible is met, some percentages do apply for out of network providers, but Aetna does not give a specific amount.
Aetna does have many limitations placed on members. For instance, out-of-network providers can be used, but the patient must handle all of the billing information themselves. Additionally, the deductible is twice as high for out-of-network coverage. Any out-of-network emergencies are still handled as in-network.
Another limitation is enrollment. Enrollment can only happen once a year. The only exception for this rule is with either a court order, adoption, or birth. In these circumstances, the person must be enrolled within 31 days.
The plan does not have any restrictions for pre-existing conditions.
Exclusions:
My current plan does not cover home births, elective surgeries, weight loss surgeries and treatments, as well as any alternative care treatments including: Acupressure, acupuncture, acupuncture therepy, non-standard allergy services, non-emergency charges outside of the United States, applied behavior tests, over the counter contraceptive supplies including but not limited to condoms, contraceptive foams, jellies and ointments Cosmetic services and plastic surgery: any treatment, surgery (cosmetic or plastic), service or supply to alter, improve or enhance the shape or appearance of the body whether or not for psychological or emotional reasons, counseling, and court ordered services. (Benefit Plan 38)
Under U.S. Law, a non-military person is protected under COBRA benefits should they lose their healthcare coverage. This method is meant as a bridge, allowing the person time to find a new plan. The rate at which the insurance is charged is raised to an individual rate, as opposed to a group rate and the copay typically doubles.
References
Benefit Plan. Aetna Choice POS II. 2012.
Medical Plan Details. Aetna. Web. Accessed 11 Mach 2012 at https://member.aetna.com/memberSecure/featureRouter/balances?product=medical&typecode=M
FAQ's For Employers About Cobra Continuation Health Coverage. United States Department of Labor. Web. Accessed 11 March 2012 at http://www.dol.gov/ebsa/faqs/faq_compliance_cobra.html
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