Health Insurance Open Season

The 2017 open season is from November 14th - December 12th, 2016.

Choosing the right health insurance plan for you and your family can be overwhelming. There are a lot of different aspects to consider. First and foremost are the monthly premiums. Keep in mind that cheaper is not always better in this department. Sometimes you get what you pay for and cheap coverage could cost you way more in the long run.

Second, what are you and your family’s medical needs for the upcoming year? Surgeries, chronic illness, and specialist visits are just a few spendy issues that you may want to consider and compare plan coverage’s on.

Third, compare how much you will pay out of pocket for services. Does the plan have copays for doctor visits or will you be paying toward your deductible and co insurance? How much is the out-of-pocket maximum (the most you will pay out of pocket a year) Are there services that are not covered by the plan that you will need that you would have to pay completely out of pocket for? These are all things I suggest you compare when looking at plans.

Fourth, are your current doctors considered “in the network” for the plans you are looking at? You get substantially cheaper rates for using in network providers with almost all plans. All health insurance companies should have an online site in which you can check who is in network for them prior to signing up for the plan.

Last, do you take regular prescriptions? What are the copays or coinsurance rates for them? Are your prescriptions covered by the plan? Is your pharmacy in network for the plans you are comparing? Do they offer cheaper rates for mail order prescriptions?

I know the process is overwhelming. It’s better to start researching plans early rather than on the last day of open enrollment. Check out opm.gov. You can compare several health plans at once on there. It’s a great tool!

The NALC has three health plans as well. Since 1950, the NALC Health Benefit Plan has provided letter carriers and their families with first-rate health insurance. The NALC’s health plan is a natural choice—as the only health plan owned and operated by letter carriers; it pays particular attention to their health needs. And because NALC health benefit plan is a not-for-profit organization, its only focus is the health of its members.

Some of the benefits of the NALC plan are access to real live humans to answer your questions when you call. They cover foot orthotics (Most plans do not cover these). Free help to quit smoking including nicotine replacement at no additional cost to you. The High plan also has several additional benefits. Check out nalchbp.org. You can read plan details for each plan.

Regardless of whether you select one of the NALC plans or not, please take the time to research your options. Whatever you select, you are stuck with for another year. Just sticking with what you’ve always had could be unnecessarily costing you extra cash.

The View from the Country Club

View from the Country Club: The Internet version: November 2016

There are some great resources on this website. Our webmaster, Heidi, has done a fantastic job of providing links to a wide variety of publications and manuals. Please use this information. Knowledge truly is power. Here, below are some of the links to videos that you might find entertaining and insightful. A great resource to find info on the day to day stories that involve the postal service is www.postalnews.com

As bad as things may seem, they can get worse. Seriously. Check this out: https://www.youtube.com/watch?v=IQ-0DXlq_2Q It’s the old postmaster stating, unilaterally, that he was going to eliminate Saturday delivery. That was only 3 and ½ years ago. We dodged a bullet there.

On October 22nd Donald Trump gave a speech where he outlined what we would do during his first 100 days (after he threatened to sue the women who had accused him of groping…sad!). During his speech he stated that he would initiate …“ a hiring freeze on all federal employees to reduce federal workforce through attrition (exempting military, public safety, and public health)” https://www.donaldjtrump.com/press-releases/donald-j.-trump-delivers-groundbreaking-contract-for-the-american-vote1 So, does this mean postal workers? Who the hell knows!

Then there’s this: https://www.youtube.com/watch?v=1r3memfIkvE Management. Numbers. And a poop cake. Again, as bad as things might be, they can be worse.

Something different. Safety. Safety isn’t funny, but this video on safety IS FUNNY. Watch it…you’ll see what I mean. Let me just warn, if you’re squeamish about fake blood ya might want to skip is…otherwise, please check out: : https://www.youtube.com/watch?v=-oB6DN5dYWo

The NALC has a longer, very well done, video on the dangers of retrieving items from the back of postal vehicles. It can be found here: https://www.youtube.com/watch?v=2nlz6i14pXw Even if you just watch the first four minutes you’ll get the point of the presentation.

Health Insurance Buzz Words

If you don't know what all those health insurance buzz-words like "co-pay" and "premium" mean, you're not alone. Most people probably don't understand all the basic health care terminology, which could be a serious disadvantage when choosing a plan during open enrollment which is just around the corner.

Not knowing these terms can be expensive.

Here are a few terms you may want to learn before you dive into a decision about your health insurance for next year.

1. Deductible

The amount you owe before your health insurance benefits kick in. For example, if your deductible is $500, your insurance won't pay for anything until your costs are more than $500.

2. Co-pay

A co-payment, or co-pay, is the amount the insured person pays every time he or she receives a health service for which a co-pay is assigned. For instance, if your co-pay to see a doctor is $25, you pay that amount each time you see him or her. The insurance takes care of the rest.

3. Co-insurance

Your part of the costs of a health service that is covered by insurance. It is calculated as a percentage and you pay it in addition to whatever deductible you may owe. For example if your plan allows $100 for a doctor visit and you've already met your deductible, your co-insurance payment of 20% would be $20. The insurance plan picks up the rest of the cost.

4. Out-of-pocket maximum

The most you pay during the period of your policy (most policies go for a year) before your insurance plan begins to pay 100% of the allowed amount. This total does not include your balance-billed charges, your premium, or the health care services your plan doesn't cover. Some plans don't count the out-of-network payments, co-insurance payments, co-payments, other expenses or deductibles toward this amount, so read the plan instructions carefully.

5. Premiums

The amount you pay for your insurance plan each month just to have the insurance plan.

6. Claim

The bill you or your doctor or health care provider submits to your health insurance company.

7. Allowed amount

This may also be called an "eligible expense" or "negotiated rate" or "payment allowance." It is the maximum amount on which payment is based for health care services that are covered by your insurance.

8. In- and out-of-network

An in-network provider is a health care office that has contracted with the health insurance company to provide services for people on that insurance plan. An out-of-network provider is someone who does not have such a relationship with the insurance company. Typically, insurance will only cover the cost of services from health care providers who are "in-network."

9. Essential health benefits

This is the set of health care services that must be covered by certain plans starting in 2014. There are 10 categories in which insurance plans must provide services and items: Maternity and newborn care, prescription drugs, rehabilitative services and devices, lab services, ambulatory patient services, emergency services, hospitalization, wellness and preventive services, chronic disease management, and pediatric services that include vision and oral care.

10. Preventive care

Routine health care that includes regular checkups, patient counseling and screenings to prevent disease, illness and other health complications that are generally covered 100% by your health plan regardless of if the deductible is met.