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Health Insurance Cost – What it really means to
you
Every year you know that you will receive a
health insurance renewal. Every
year the premium increases. Either
you accept the increase as presented by the carrier, or you are forced
to review the health plan and send it out to the market place to be
bid on by other carriers. It
has become, unfortunately, part of our cultural psyche to know that
health care cost will increase every year.
One primary reason for the continued increases is
the higher cost of services. To
illustrate these increases, we thought it would be interesting to
compare an employer group plan from the year 1958 to an employer group
plan from the year 2000. Just
stop and think about how much things have changed over 42
years.
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Benefit
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Blue
Cross Blue Shield Hospital and Surgical-Medical plan
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Blue
Cross Blue Shield PPO plan
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Year
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1958 monthly premium
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2000 monthly premium
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Individual
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$2.48
(not a typo)
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$247.17
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Family
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$7.76
(not a typo)
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$602.00
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The individual plan increase is 9,966.53%,
or 11.88% per year. The
family plan increase is 7,757.73% or 11.2% per year.
As the year 2000 ends, the average health care cost increased
by 8.1%.
Eligibility for dependents in the health benefit
plan compares as follows:
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In 1958, eligible dependents would include
husband, wife, and any unmarried dependent children under the
age of 19. Benefits
of coverage are available to them except of course, maternity
benefits, which are available only with Family coverage and only
for the wife.
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In 2000 eligible dependents are; dependent
children, adopted children, stepchildren, children placed in the
home, or children for whom the employee has legal guardianship.
Dependent children must be under the age 19 or under the
age 23 and full-time students; or incapable of self-sustaining
employment because of mental or physical handicap that began
before the child reached age 19.
In addition, it is now possible to provide coverage to
Domestic Partners, whether same or opposite sex.
In addition, it is legally mandated for any employer that
conducts business WITH the City of San Francisco to provide
coverage for Domestic Partners.
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As a side note to the above, pregnancy is now
mandated by law to be treated the same as any other illness. So, coverage is extended to any covered pregnant female who
is an eligible dependent. In
1958, you had to satisfy a ten-month waiting period to have coverage
for a pregnancy.
Now, let’s look at what the plans cover:
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1958 Benefits
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2000
Benefits
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Hospital
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Receive the first 21 days paid in
full and the next 180 days at 50% discount.
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Unlimited days simply subject to medical
necessity.
Extended Care Facility if needed 60 days
per year
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Maternity
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For the wife under a Family membership an
allowance of $80 towards hospital charges for delivery.
For other conditions that arise out of pregnancy, an
allowance of $8 a day up to 10 days will be
provided for Maternity Care.
Obstetric delivery paid at $75
Cesarean section paid at $125
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Prenatal and Postnatal care treated as any
other illness.
In-network is co-pay for the first
visit, thereafter 100% coverage.
Out-network is subject to the
deductible and co-insurance.
Average cost for a normal Obstetric
delivery is $6,000.
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Communicable Diseases
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Polio Hospital service benefits will be
provided for a period of 21 full benefit days and 9
discount benefit days, only during the first 60 days of
the onset of poliomyelitis.
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Communicable diseases are no longer a
separate item but rather part of the medical benefit.
Additionally, most diseases such as polio are not a
threat today.
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Mental or Nervous Disorders
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When shock therapy treatment for a
subscriber requires overnight hospital stay, hospital service
benefits will be provided for one day.
A maximum of 10 such shock therapy treatment days
will be provided in each contract year.
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In-network, co-pays only.
Out-of-network, deductibles and
co-insurance.
Limits:
In-patient stay, up to 30 days.
Outpatient therapy 20 visits per year.
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Emergency Room Visit
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An allowance of up to $7.25 toward
the hospital bill is provided for outpatient hospital service
when you are not a registered bed patient.
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A co-pay of $50 and then everything
thereafter covered at 100%.
The $50 is waived if admitted to the hospital.
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Electro-Shock Therapy
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Allowances will be provided up to $100
during each contract year, for electro-shock therapy, in or out
of the hospital, at $10 per treatment.
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Most doctors today would normally
prescribed a prescription medication for the treatment of
depression.
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Amputation of a Finger
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$40
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The finger either is corrected with surgery
or is reattached. Amputation
is rare, so there is no comparison.
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