On 2/5/2022 10:32 AM, Mike Duffy wrote:
> On Sat, 05 Feb 2022 10:03:35 -0500, jmcquown wrote:
>
>> Needless to say, our group insurance premiums
>> went through the roof at renewal time.
>
> I'm glad you did say it, because it corrects something I had always
> incorrectly assumed. I had always assumed that the 'group' was the
> ensemble of all employees across all the employers who insured at a
> particular level (i.e. defined set of insurable ailments).
>
> This would be akin to an individual, who pools his likelyhood of specific
> ailments with the ensemble of those sharing his main demographics.
>
> But you imply that the insurer looks at each employer, and for a given
> level of coverage comes up with a quote, presumably taking into account
> the demographics & actuarial statistics of that small group of employees.
>
That is correct. It isn't an insurance pool, which is usually comprised
of a group of small companies in similar industries who "pool" their
resources to get coverage for their employees. Group insurance plans
are sold to a single company.
> What percentage of the premium is paid by the employer vs. taken off the
> employee's paycheck as a deduction?
>
It depends on the employer. Some will pay 100% of the cost, others ask
the employees to pay a portion of the premium via payroll deduction.
> Pardon my ignorance, but here in Canada there is a certain level covered
> by general revenue, but many employers offer extra health insurance for
> items not included in the basic coverage. (Dental work, Eye-glasses,
> Prescription Meds, &c)
>
It depends on the plan(s) offered by the employer. IME, they shop
carriers every year. They sometimes offer more than one and the
employee chooses. PPO vs. Major Medical. Most group insurance plans
usually provide prescription coverage with a minimum co-pay. Sometimes
vision and dental is included. If they change carriers those benefits
may become optional; the employee decides if they want to pay a little
extra for them.
One year I got a dental crown in January. The first time I had been to
see that dentist was in December, at which time I had 100% dental
coverage from Prudential. The company changed carriers to Aetna
effective January 1. After I got the crown, I got a $400 bill from the
dentist because Aetna considered porcelain crowns "cosmetic". It would
have been covered 100% if the crown was gold or if we were still insured
by Prudential but they switched carriers to get a better group rate.
The dentist's office didn't verify the coverage before giving me the
porcelain crown. They assumed I still had the same insurance carrier
and coverage. I got lucky; they were supposed to have verified the
coverage first so he wound up eating the cost. The crown is in the back
of my mouth, I didn't care if it was porcelain or not, no one could see it.
> On the face of it, it would seem to behoove an employer (in your case) to
> pay for perks that would improve health. This would lead to savings for
> the employer in the long run both for his share of premiums, and making
> the employment more desirable by reducing the employee share of the
> premiums.
>
> (Banning smoking, replace Coke with juice in vending machines, salads vs.
> fries in the cafeteria, &c)
It does behoove employers to pay for perks that improve health.
Preventive care. Gastric bypass surgery isn't a "perk" and it's not a
magical cure for people who aren't willing modify their eating habits.
Jill