I was curious about how the “Baby Cash” benefit works. The benefits booklet says you get $4000 each time you have a baby. How easy is it to avail this benefit?
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Also, the time off is pretty decent for the US
What that means is you will only pay copays (very very low copays typically) for services done by inn network providers upto the oopmax limit then copay goes away.
For example, (for inn network) in the epo plan Dr visits, urgent care specialist etc are all 15 flat copay, er visits/hospital stays are a grand total 100 copay per admission, and all labs, diagnostic etc are covered 100... The cons of this plan are making sure you stay in network, but if your providers are in network, this is a very very terrific plan. (Daughter went to ER other day (she's fine thank goodness) entire 2 day stay cost a grand total of $100 and will only cost me $100. Its nice to know that I don't have to worry about thousands in care costs, just that my daughter is okay... My wife has surgery planned in may, it will cost like 145 because technically 3 visits involved in that procedure and a surgical room booking.
However, once again, if you knowingly seek nonemergency care outside of network, it's the same as not having insurance (except you MAY be able to appeal, but not something to bank on)
Epo has different names all meaning in only including hmo, epo, pos... All mean slightly different things but generally when you see these plan names think inn network only.
Ppo is different is preferred provider plan. It has 2 drastically different coverage levels, it covers inn network, but if you choose an out of network provider then they cover basically half as well (but still something)
In ppo plans you see two sides of coverage inn and oon
Most ppos are set up in a tiered coverage level as well
The major numbers are deductible (amount you pay out of pocket before insurance helps out even a nickel) coinsurance (usually set at 10,20,30...%) this means once deductible is met, say you go to doctor again and bill is $100 because that's what the insurance allowed the Dr to charge, say your coinsurance is 10% then you pay $10 and insurance pays $90.
Coinsurance continues until the amount paid in deductible + coinsurance from the member in a given year meets out of pocket max (oopmax) this is the maximum amount that an individual will pay out of pocket for coverage in a given year FOR THAT NETWORK TRACK.
Yes you have a inn oopmax And an oon oopmax.
Ppo is useful for people who have extenuating needs that are not provided by inn physicians (say a family friend Dr, that is not in network, or maybe a private practice Dr that they prefer to see over in network providers) but you end up paying a great deal more for care costs generally in a PPO than a epo, although further hoops to jump through in ppo vs epo.
Health insurance is confusing, there's tons of YouTube videos that explain this all better I'm sure ( I used to consult for health insurance companies)