Medical Insurance for Pool Players and Billiard Related Businesss

[MikeJanis]

Mike,

I'm 24 non-smoker with no dental or vision. My firm is small so rather than a company plan we're paid a stipend and we procure our own coverage.

Through Kaiser-Permanente:

Initially I had a comprehensive Individual HMO with $10 co-pay no deductibles, etc. etc. The full monty and I was paying ~$180/mo.

Since I'm young and indestructible (I haven't had a non-routine doctors visit in 7 years) I recently switched to a co-insurance PPO. I pay the first $1500 straight up then Kaiser takes over. This is approximately $90/mo.

I know I'm not your typical demographic but I thought I'd throw it out there. Good luck.

-J

Thanks James, any info I can get helps. I remember being young and indestructible once......Ummm, about 15 years ago but now at age 39 things start to catch up. I hope you stay in better shape than I did. As far as the demographics go: I'm not sure what they are its just an option we wanted to offer to all the Viking Tour members. I hope it will benefit many.

Mj

 

[MikeJanis]

This is what I have. It took some cutting and pasting but I think I have everything correct.

Lifetime Maximum Per Person $5 Million

Calendar Year Deductible $1,000/person $2,000/family After Deductible
Plan Pays 80% of Next $10,000 then Plan Pays 100%
Coinsurance Calendar Year Max Out of Pocket $3,000/person -Includes Deductible!

Physician Office Visit
-Primary Care Physician $35 copay per visit


Childhood Immunizations Plan Pays 100% -Birth to Age 5
Routine Lab Tests and X-Rays First $200 covered at 100%, then 80% after deductible
Inpatient Hospital Services 80% After Deductible
Outpatient Facility Charges 80% After Deductible

Emergency Care $75 copay per visit (waived if admitted to hospital)

Optional Maternity Care Not Included Not Included

Outpatient Prescription Card
-Level I (Generic) $15 copay (Drug deductible does not apply)
-Annual Deductible Per Person (Non Generic) $500 if Optional Rider Not Selected
-Level II $35 copay after drug deductible
-Level III $55 copay after drug deductible

This Is What I Pay Each Month for Me and my Wife for the above
Mike Janis & Spouse Monthly Premium
Total $402.19
Optional $0 Drug Deductible for name brands $62.08

Its about 40% less than what we were paying before.

All services applied to the deductible are discounted by the Preferred Provider Organization (PPO).
This means that normally a hospital would charge me as a normal individual say $500. They would charge most Ins companies say $300. Based on this my copay would only be based on the $300 charge (20% of $300 = $60 instead of the 20% of the $500 = $100).


Does anybody pay for their own Health Care Coverage that this can be compared to ? Is it a good deal, mediocre or bad ?

If you have anything to compare it to (Apples to Apples) please let me know. If its bad I need to do more research to get a better deal for the Viking Tour members.

Thanks,

Mj

 

[Black-Balled]

I want your job......

Wanna trade ?...

What can I say? It ain't all cotton candy and happy faces...I might like to trade with you though.

I will tell her that for ya Walter and I will give he a big "Helloooooow" for ya! She loves that buddy.
Don P.
She just asked me "Where are my circus tickets?"

You 2 can get to see every Show for free. You ever swing on a trapeeze? Pick up animal waste? How about both in the same hour? I will send you a job application, but you gotta promise to never stick your wang in the tiger cages.

 

[jdr]

Hey Mike,

I'm an actuary who works in health insurance. $400 sounds about right for that kind of plan and your age group. In general, premiums are heavily dependent on geography and I'm not really familiar with your area so it's hard to tell. (i.e. if you live in Manhattan, it's probably more expensive than if you live in rural Idaho).

Also, it sounds like you may be getting individual rates. Group rates (unsubsidized) will generally run cheaper. (There's a lot more risk to the insurer under Individual insurance.) If you can get a lot more members of the tour to purchase insurance, you could probably negotiate as an association or discretionary group depending on the laws in your state. Alternatively, you may want to talk to an health purchasing association that's already in existence (i.e. Administaff or AARP) and try to join them.

Also, there are probably laws in your state about the "prudent lay person" definition of Emergency, so you may want to look into that. It may help you with your dispute.

Good luck.

 

[MikeJanis]

Hey Mike,

I'm an actuary who works in health insurance. $400 sounds about right for that kind of plan and your age group. In general, premiums are heavily dependent on geography and I'm not really familiar with your area so it's hard to tell. (i.e. if you live in Manhattan, it's probably more expensive than if you live in rural Idaho).

Also, it sounds like you may be getting individual rates. Group rates (unsubsidized) will generally run cheaper. (There's a lot more risk to the insurer under Individual insurance.) If you can get a lot more members of the tour to purchase insurance, you could probably negotiate as an association or discretionary group depending on the laws in your state. Alternatively, you may want to talk to an health purchasing association that's already in existence (i.e. Administaff or AARP) and try to join them.

Also, there are probably laws in your state about the "prudent lay person" definition of Emergency, so you may want to look into that. It may help you with your dispute.

Good luck.

Good informations. THANK YOU !

I will look into it.

Mj

 

[James]

Does anybody pay for their own Health Care Coverage that this can be compared to ? Is it a good deal, mediocre or bad ?

If you have anything to compare it to (Apples to Apples) please let me know. If its bad I need to do more research to get a better deal for the Viking Tour members.

Thanks,

Mj

Mike,

Not to sound like a broken record, but www.ehealthinsurance.com is an online insurance broker. They will give you free quotes without having to fill out any personal info or call. You just punch in Age, sex, spouse, children, smoking, etc. and your zip code and it'll give you pricing for all sorts of different plans and providers. This will allow you to compare your current pricing with other providers.

Give it a try.

-J

Edit: So I'm bored and I just tried it out for you. Assuming you and your wife are both 39, living in 30033 zip code and smokers... I looked for plans with 20% co-insurance and $1000 deductible which is what you described above. Your pricing fits the average for what is available through this particular broker. However as someone else mentioned, these rates are individual plan rates for sure. There really isn't any appreciable savings for someone to buy this through you than just on their own. You should see if you can negotiate group rates based on a number of subscribers.

On a side note Mike, I'm not sure what type of coverage you previously had, but I hope you realize that the coverage you are showing for your wife and yourself is definitely the "catastrophic" type. It is only going to be a savings if you rarely/ever are going to the doctor. It will keep you from going broke in the case of an emergency but will be very costly for regular visits and small mishaps. If this is unclear, feel free to PM me and maybe I can give you a call. Since my company did not offer coverage I was forced to research this all on my own and now I know more than I should about health care plans...

-J

 

[MikeJanis]

Mike,

Not to sound like a broken record, but www.ehealthinsurance.com is an online insurance broker. They will give you free quotes without having to fill out any personal info or call. You just punch in Age, sex, spouse, children, smoking, etc. and your zip code and it'll give you pricing for all sorts of different plans and providers. This will allow you to compare your current pricing with other providers.

Give it a try.

-J

Edit: So I'm bored and I just tried it out for you. Assuming you and your wife are both 39, living in 30033 zip code and smokers... I looked for plans with 20% co-insurance and $1000 deductible which is what you described above. Your pricing fits the average for what is available through this particular broker. However as someone else mentioned, these rates are individual plan rates for sure. There really isn't any appreciable savings for someone to buy this through you than just on their own. You should see if you can negotiate group rates based on a number of subscribers.

On a side note Mike, I'm not sure what type of coverage you previously had, but I hope you realize that the coverage you are showing for your wife and yourself is definitely the "catastrophic" type. It is only going to be a savings if you rarely/ever are going to the doctor. It will keep you from going broke in the case of an emergency but will be very costly for regular visits and small mishaps. If this is unclear, feel free to PM me and maybe I can give you a call. Since my company did not offer coverage I was forced to research this all on my own and now I know more than I should about health care plans...

-J

The only one on that site that I saw the even came close to what we have as about $180 per month more. AND it does not offer the discounted rate for the co-pay.

Copay Select

AM Best Rating: A Plan Type Deductible Coinsurance Office Visit
Network $1,000 20% $25
$580.69
Monthly Cost

 

[James]

I took a few quick guesses on age and zip code. Those are going to affect the plan greatly. So it sounds like you're getting a deal, but please do take note of the second 1/2 of my post regarding the levels of coverage.

I personally have that level of coverage and I'm ok with it but I know that it's a common misunderstanding regarding co-insurance leaving people stuck with extensive bills in the case of minor injuries.

-J

 

[branpureza]

Hypothetically speaking... would I be covered if I were to say.. bust my head open on the corner of a pool table?

I just want to cover all my bases on this...

 

[James]

Hypothetically speaking... would I be covered if I were to say.. bust my head open on the corner of a pool table?

I just want to cover all my bases on this...

You mean if you were "Petrowned" ?

 

[cleary]

For my wife and I, I pay $195 for medical, dental and vision through empire blue cross/blue shield, however, I believe my work covers half so it might be more like $400.

 

[jgpool]

$161.44 a month.

Mine costs me 161.44 a month. Blue Cross Bule Shield, Preferred PPO for me and my wife. $500 yr deduct. Any Dr., $20 co-pay, $5/10 prescriptions. It's a good plan with a large company.

 

[john schmidt]

hi

im interested for sure.let me know more

 

[MikeJanis]

Mine costs me 161.44 a month. Blue Cross Bule Shield, Preferred PPO for me and my wife. $500 yr deduct. Any Dr., $20 co-pay, $5/10 prescriptions. It's a good plan with a large company.

Is this on your own or does your employer pay a portion as a benefit ?

 

[DEAD MONEY G]

Help me out here a little bit Guys and Gals.

Do you have Healh/Medical Insurance ?

Single, Married, Family ( # of ) ?

How much do you pay ?


Any info you can give might make this better for all the Business and Players that want/need insurance.

Right now my Wife (44) and me (39) pay about $950 per month for our insurance (Med, Dental, Vision) + Smokers. This program reduces it to about $530 per month for us.

Thanks,

Mj

I work for NY state i pay $70 every 2 weeks and i get full medical with $12 copays and my union covers dental and vision with no fee at all for me I have a wife and 2 kids and we are all covered under my plan

 

[MikeJanis]

im interested for sure.let me know more

John. keep an eye our for a Press Release real soon. Also, as a Viking Tour member you will get a notice either through email or regular mail.

Just in case I do not have your email address please send me a quick note to vikingtour2@yahoo.com and I will add you to our list.

Thanks,

Mj

 

[MikeJanis]

I work for NY state i pay $70 every 2 weeks and i get full medical with $12 copays and my union covers dental and vision with no fee at all for me I have a wife and 2 kids and we are all covered under my plan

That sounds suspicious..........Are you 5-O ?

Just kidding, it sounds like you have a great job. What do you do and does it leave you any time to get out and play pool ?

 

[DEAD MONEY G]

That sounds suspicious..........Are you 5-O ?

Just kidding, it sounds like you have a great job. What do you do and does it leave you any time to get out and play pool ?

I work doing the heating and AC at a state college the hours suck (midnight-8 AM) the pay sucks about 40k a year with overtime its about 55 but the benefits and time off are great some of you may think 55k a year is ok but with a wife and 2 kids and living on long island its nothing my wife also works about 25 hours a week.I get to play about 10 hours a week which has made me a solid b player. i used to be a low A player but at this point im just hoping not to get worse just stay the same spped

 

[Black-Balled]

Hey Mike,...Group rates (unsubsidized) will generally run cheaper. (There's a lot more risk to the insurer under Individual insurance.)...Good luck.

Yes- as a Benefits Plan Mgr, I get to wire money to the health plan to cover $ paid for services of our participants.

You don't want to know the total..per week. I doubt many on these boards make that much in a year...

 

[MikeJanis]

Update: We ( The Viking Cue 9-Ball Tour / aka: 8002007665, Inc.) will definately be adding this Health Care program for our members.

To make this a benefit to everyone in the billiard community we will also be offering Open Enrollments to become a Viking Tour Non-player member, or non-host location member so everyone can take part in this offering if they wish to.

Thanks for all the nice letters of support and help to me for getting this program off the ground.

Look for our Press Release coming in the following week/s that will detail all the new benefits from the Viking Tour to our membership.


Mj