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Is it safe to ask your employer about benefits their health insurance policy provides that I may want to use before I sign up for the health insurance they offer?


I am thinking about signing up but want to know first if I can get a health procedure done that may cost 5-10K, and may want to take care of a few other items at the same time that could bring that number higher.


The concern is that if asking my company if this procedure is covered under their health policy significantly or completely, so only have to pay a small amount or nothing of that 5-10K, that this may cause the cost of their health insurance policy to go up and that I imagine would not be looked upon favorably as regards me. Also I am one of their "older" employees, and they may think their is more of a chance of me using the health insurance increasingly over time. Fortunately my health is very good and I am not officially "old" yet LOL.


Also, my union told me to get their health insurance policy rather than the one my company offers, saying their policy is better (no explanation was given as to how the union policy is better). In general, are union health policies generally better than the company ones?


And since the union is more favorable to employees in certain matters than the company, I have the same question above as to whether I can inquire safely if I can get the procedure I want to do from the union rep.


Or perhaps 5-10K will not impact the cost of the health insurance my company and my union offers?


If so, is their a point at which it is no longer safe to inquire about benefits a health insurance policy would cover if the company or union perceives that benefit would be costly and cause their insurance premiums to rise due to an employees use of them (i.e. if you needed a major surgery that would cost 100K).

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Yes, know the difference between HMOs and PPOs.

HMOs you are pretty much locked into their network of providers. I found that the doctors I liked in my area, were not in the the network and the ones who were, I wouldn't take my dog to.

PPOs have their network and they pay more if you use network providers. If you go out of the network, they don't cover as much but u can go out of network.
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In order to find out if a procedure is covered, you need to ask your doctor or surgeon for the code(s) that they will submit to the insurance company. You then call the 800 number for your insurance plan and ask if they will pay for that, what the copay or coinsurance will be.

In order to evaluate insurance plans and do a legitimate comparison, find out if HR has a chart that lays out a spreadsheet that compares all plans. Educate yourself about the differences between an HMO a PPO and plans that have no networks. If you have established relationships with doctors find out if they are in-network and which plans they prefer to work with.

You don't talk to your company about what medical procedures you will be having done or considering the cost to them. You tell them when you need to take c time off for a procedure. Anything else is our own business. They provide an insurance plan and that's the end of it.
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Clemente Oct 2021
Wonderfully refreshing answer, thanks Barb and all the others hear who made it easy and clear to understand. I am much better prepared now for what to do.
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I'd talk to the insurance reps for each plan, not HR or union people. I always found HR knew less than nothing about the benefits they offered.
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Could you call each of the insurance companies?

If you don’t have their numbers, perhaps the employer could give it to you, in the guise of comparing plans.

Or, perhaps a colleague could give you the phone number off of the back of their card.
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I doubt HR knows the in and outs of the policy. My husband is covered by the UAW. We have a choice between 3 policies. We have stayed with Traditional because I refuse to go to a Medicare Advantage. The UAW covers my husband health, Vision, orescriptions and Dental. I pay a small amount a month, under $100, as his dependent. You need to ask the Unions benefits to send you info on what they cover. As your company the same things. Both should be able to provide booklets. Then you sit down and compare the two coverages, pros and cons.

The deductable is the main thing to consider. It can be as high as 6k. Meaning you need to meet that before the policy pays.
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You can ask the employer for the policy details so you can read it yourself thoroughly and do call the insurer to clarify anything. Bridger is correct that the cost to the employer is also in the loss & training a replacement for an employee. It’s none of their business but considering your age I would not give away the fact you are considering a procedure that may incapacitate your for a significant amount of time.
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Do you have adequate time off? The cost to the employer is more than health care costs. Also have you checked your insurance to see if their are any waiting periods for the procedure. Are the medical procedures immediately necessary? Or are they elective?
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You should get information on what your insurance covers in any case.
You should have information on the company policy as well as information on the Union policy.
How can anyone make an educated, informed decision if not all the information is presented?
Request the information from HR as well as from the Union rep read the information and then make your decision.
To get this information you do not have to disclose any health information.
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