Federal health insurance plans

[Anonymous]

I am waiting for a formal confirmation letter of employment with the Federal Gov, and would like to know what other parents in this forum think of health plans out there if you are a Federal worker. We currently have United Health care, which covers some of the out of network fees. DC's providers are mostly out of network (we see ST, OT, PT and Counseling). We have a high deductible, and we live in MD.

TIA for any info that you could provide.

[Anonymous]

I'm a federal employee and we are planning to switch to GEHA Standard Benefit Plan. The premiums are low and the plan covers 65% of out of network services. The deductible is only $700, I think. I'd like to hear what other Federal employees do . . .

[Anonymous]

Have 2 special needs children. We have BCBS standard.

[Anonymous]

We have BCBS Standard. BCBS Basic and Standard are popular throughout my agency, but pretty much all of my colleagues who have kids with special needs that require out-of-network services have BCBS Standard.

[Anonymous]

We have NALC high. Low premiums and covers 70% of their allowance, which is usually close to the provider's actual charge.

[Anonymous]

GEHA uses the same network as United Health. I used to be in BCBS for years and switched to GEHA last year. The only thing BCBS was better for me was some brand name medications. Everything else GEHA is similar/better with much lower premium.

[Anonymous]

Anonymous wrote:We have BCBS Standard. BCBS Basic and Standard are popular throughout my agency, but pretty much all of my colleagues who have kids with special needs that require out-of-network services have BCBS Standard.

I think the relative value of GEHA and BCBS standard depends on how often you see out of network providers. GEHA has a higher copay, but a lower monthly premium.

GEHA Standard pays 65% of the negotiated rate for out-of-network, and if the out of network provider charges more than the negotiated rate, you have to pay the difference between to two rates AND 35% of the negotiated rate. But the GEHA Standard premium for a family (employee share) is only $282.

BCBS Standard will bill you for the difference between the two rates, plus 15% of the negotiated rate (as your copay). But the BCBS Standard premium for a family (employee share) is $589.

Another big cost issue is how much your out of network providers charge relative to the negotiated rate.

[Anonymous]

Anonymous wrote:I'm a federal employee and we are planning to switch to GEHA Standard Benefit Plan. The premiums are low and the plan covers 65% of out of network services. The deductible is only $700, I think. I'd like to hear what other Federal employees do . . .

We are on GHEA standard and have had a very good experience.

[Anonymous]

You have to watch anything backed by United. The policies look good on paper, but when you try to claim they deny everything and you can't get anyone on the phone in under two hours. I switched from my plan (which has better nominal benefits ) to BCBS Standard - everyone takes it around here.

[Anonymous]

We have GEHA standard and like it. As others have said above they pay 65% for out-of-network and the premium is low. They use United Healthcare network for clinical care. They are usually very quick to reimburse for out-of-network (usually 3-4 weeks after submitting forms which seems quick for an insurance company).

[Anonymous]

Was anyone able to get coverage for a neuropsych eval using GEHA? Interested in both in network and out of network. Specifically Stixrud and KKI.

[Anonymous]

We have GEHA and had neuropsych eval with out of network provider (not Stixrud) and paid $2500 out of pocket and GEHA reimbursed $650.

[Anonymous]

I am federal for close to 15 years.
Over the years I believe we tried many PPOs (BCBS, SAMBA, NALC, APWU)
Here is my take.
1. Be very careful ALL for next year. Read booklet when available in two weeks.
There is new trend to separate In-NETWORK an OUT -of NETWORK deductibles. THIS IS NEW for 2018.
It can hit you HARD.
2. Many popular psychologists in DC area do not take Insurance, so look for Out of Network coverage.
3. BCBS - very expensive, but extremely popular in this area. There is no reason to hold to it. Most doctors take Cigna.
We left BCBS many years ago and do not look back. They are overpriced.
4. Look for specific for your family. Look at premiums, networks, deductibles, copays etc. Add all together.
We change plans almost every year, depending on above. So far so good.
My family always go through $5000 of Flexible spending account. (It is never enough.)
Here is what important for my family:
-We regularly use ton of doctors for many different reasons, who do not insurance.
-We systematically visit urgent care centers (not ER)
-We need accidental injury, since someone will break something... (have multiple kids and sport)
-We have allergies etc.
I hope this would help.
So short answer, no perfect insurance.

[Anonymous]

We've had BCBS Basic for a while and we have secondary insurance through the Katie Beckett waiver. It's been great and even though we didn't have anything extraordinary this year (no surgeries or hospitalizations), we reached our individual limit for my son early fall and therefore have no out of pocket (or Medicaid reimbursable) expenses for the rest of the year. Assuming everyone else in the family is healthy, I think Basic is a better option than Standard.

[Anonymous]

What is the Katie Beckett waiver?