Federal Health Benefits - BCBS Standard or Basic for Maternity and Birth Delivery
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Anonymous
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I am a federal employee in MD and looking to see which one of the BC/BS plans would be best for us. I read several posts in another thread that BCBS seemed to be the best one for maternity and delivery care. For Basic option, there is $150 flat fee for the hospital admission. For the standard option, there is no fee but there is $700 deductible for Self and family which I assume I will have to pay fairly early considering my due date is Feb 2013.
Also wondering about circumsion benefit, since it says it is covered as a surgical benefit. I read that there is $150 per surgeon and if a co-surgeon is present, there is an additional $150. Any thought? |
Anonymous
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Thanks for asking this. I am in the exact same boat but we are going to be TTC.
I currently have the BCBS basic so I am wondering if I should go with the standard or leave as is? Definitely interested in reading others thoughts. |
Anonymous
| All I know is that I had two babies under the BCBS FEP Standard plan (4/09 and 4/12) and paid ZERO dollars for both, including OB appointments, delivery, post partum care, and well pediatrician visits. |
Anonymous
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You are wrong about the deductible, OP. First, even though your family deductible is $700, you as an individual only have a $350 deductible, so you will stop paying deductibles if either you hit $350 or your whole family hits $700 as a group--whichever happens first.
BUT there is no deductible for maternity care under BSBC Standard. This is why 12:41 PP was able to pay nothing for both of her deliveries under Standard with Preferred Providers. For Basic, it would be more expensive, because you would pay $150 admission for your delivery. But the other items listed by PP, post-partum care, OB visits and well pediatrician visits are all included free of charge under Basic, again assuming that you are using a Preferred Provider. Circumsion is a separate benefit from maternity care, because it is the baby's surgery. Under BCBS Standard, the deductible would apply. If the baby or family hit the deductible before the procedure (not likely), you would then pay 15% co-insurance on the procedure. Under BCBS Basic, you would have no deductible, but a $150 co-pay for surgeon and 30% co-insurance if any billable supplies were used during the surgey. Hard to imagine a second surgeon on something as simple as a circumsion, but theoritically, yes, a second surgeon means a second co-pay under Basic. Overall, one of the biggest risk under Basic is that the baby is admitted to the NICU for several days, because hospital co-pays for non-maternity care are much higher for multiple day stays under Basic then Standard. Also, if someone needs a lot of additional surgeries and procedures, Standard may save money, because Standard has lower co-pays and carries 15% co-insurance instead of 30%. However, for most people, Basic is significantly cheaper, as long as you can use Preferred Providers. I recently switched from Standard to Basic, so I have spent a lot of time with the benefits brochure! They also have a hotline where they basically walk you through it. Call the customer care line and they will give you the plan comparison 1-800 number. |
Anonymous
| I have BCBS standard and paid nothing for prenatal care or delivery last year (2011). I think the deductible only applies if you are out of network (either OB or hospital). |
Anonymous
| 15:45 - thanks for your response. I am also trying to decide between the two. One reason I am having difficulty seeing the benefit of Standard over basic is the 15% you have to pay for most procedures. It worries me that you don't know upfront what that amount is. For some things like MRI etc it could be a lot of money whereas basic is a set price. I have no issue paying more for the standard if I thought it provided better benefits but I'd rather pay a set copay with basic than 15% of every test, etc which could get very expensive fast. |
Anonymous
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Ive been watching this thread eagerly hoping someone will give insight. I have the same response as the 1831 poster- I am trying to decide between the two, and cant imagine why Standard would be better if 1 )you have to pay 15% of procedures and 2) the premiums are higher. the only real advantage I can see is the out of network thing, but given the difference in cost it seems like it would make sense to pay out of pocket if and when that ever happens.
what am I missing? |
Anonymous
Nothing - the only benefit to the Standard is the out-of-network provider benefit. Not worth the extra money in my opinion unless you already know you need an out-of-network provider - Federal BCBS is HUGE in DC, so the chances that you wouldn't be able to find a great, in-network provider is slim. |
Anonymous
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Thanks, PP. This is the persona wondering what the point of Standard really is, and you affirmed what I understood from the benefits.
I did notice on the other thread however that if you have children in the NICU the costs actually might be better for Standard. Has anyone been in this situation? as I mentioned there: We just found out we are expecting after IVF. We transferred two and thus there is a chance that I may be expecting twins, which obviously have a better chance of being in the NICU than a singleton would. Not sure what to do, the changes of twins are only 25%, and we won’t find out how many I am carrying until after open season. In every other sense, Basic makes more sense for our family... |
Anonymous
| Also, what are people allocating for FSAFEDS for the pregnancy/birth process with BCBS? |
Anonymous
I would stick with Basic in this instance. Actually having the child counts as a life event for which you can make a change outside of open season, so if you have twins AND if they need ICU time, you can make the switch to the Standard plan when you add the bab(ies). |
Anonymous
| FSAFEDS: I've been wondering the same. The benefit covers classes, so that's ~$350, and if you search there's a few threads on how to get doulas covered, so approx $1000. That's as far as I've gotten so far. |
Anonymous
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Oh- thanks! about the reminder of a doula. We've had that reimbursed in the past and definitely will try again.
So: 1) Doula = $1000 2) Birth = 150 (Vaginal) or 250 (C) 3) First co-pay ped = $30 (?) 4) Pregnancy care co-pay = 30 5) Special test co-pays?? THanks! |
Anonymous
I'm not sure what you are talking about PP. These numbers do not match reimbursements under either BCBS plan. Are you looking at another insurer? Under BSBC Standard: 1) Not sure. 2) $0 3) $0 well child ($20 if you have a sick visit) 4) $0 5) Depends. If "maternity," then $0, otherwise 15% after deductible plus $30 co-pay to see a specialist if test is covered. If it is too "special" to be covered, you pay out of pocket, and with a non-preferred provider, you pay more. Under BSBC Basic: 1) Not sure. 2) $150 either birthing method 3) $0 well child ($25 if you have a sick visit) 4) $0 5) Depends. If "maternity," then $0, otherwise a co-pay that can range from $25 to $100 for procedure plus co-pay of $35 to see a specialist and 30% of supplies used, but no deductible. Of course, if it is too "special" to be covered or you choose a non-preferred provider, you pay out of pocket. |
Anonymous
| I've got Federal BCBS Standard but I believe it is a local plan. I've noticed BCBS listed under the nationwide plan. Anyone know the difference? Is nationwide what you mean when you say you have BCBS Standard? |