Not even the worse insurance plan would do that. Or is it, $200 max per doctor visit and you pay rest? But then there is a yearly limit as well of out of pocket. Doesn't sound right

Starting in 2014, the Affordable Care Act bans annual dollar limits. Until then, annual limits are restricted under the Department of Health and Human Services (HHS) regulations published in June 2010.

For plan years starting between September 23, 2010 and September 22, 2011, plans may not limit annual coverage of essential benefits such as hospital, physician and pharmacy benefits to less than $750,000. The restricted annual limit will be $1.25 million for plan years starting on or after September 23, 2011, and $2 million for plan years starting between September 23, 2012 and January 1, 2014. For plans issued or renewed beginning January 1, 2014, all annual dollar limits on coverage of essential health benefits will be prohibited.
Protecting Coverage for Workers

A small number of workers and individuals only have access to limited benefit, or “mini-med,” plans with lower annual limits than are generally permitted by law and which can provide very limited protection from high health care costs. Employers and insurers estimated that requiring mini-med plans to comply with the new rules could cause mini-med premiums to increase significantly, forcing employers to drop coverage and leaving some workers without even the minimal insurance coverage they have today.

In order to protect coverage for workers in mini-med plans until more affordable and more valuable coverage is available in 2014, the law and regulations issued on annual limits allow the Department of Health and Human Services (HHS) to grant temporary waivers from this one provision of the law that phases out annual limits if compliance would result in a significant decrease in access to benefits or a significant increase in premiums. Plans that receive waivers must comply with all other provisions of the law and must alert consumers that the plan has restrictive coverage and includes low annual limits. Additionally, these waivers are temporary and after 2014, no waivers of the annual limit provision are allowed.

http://www.cms.gov/CCIIO/Programs-and-Initiatives/Health-Insurance-Market-Reforms/Annual-Limits.html


Something here is not making sense. It looks like the coverage the brochure describes would be illegal after January1, 2014. Maybe this has something to do with the 1 year extension for employers? Looking over the brochure, there is no reference at all to the ACA.

It produces an uniquely American steaming pile of shit. Seriously, what a nightmare everyone went out on a limb for (still).

Yeah, yeah, I know. Single payer was never viable because Democrats aren't progressive enough for it or some other reasonable excuse

Many waivers have been given. Even if it's not a waiver, the president thinks he can delay any part of the law he wants without congress (hope we don't have an R president in 2016).

This waiver was very common a couple of years ago. I thought this one hat had stopped, but it looks like they are still giving the waiver instead of having employers drop coverage completely (which is what employers - mostly restaurants - threatened).

the problem is that they haven't updated the web site with next year's plan. It's my guess they will drop coverage, pay the fine and refer employees to the exchanges.

I think I saw elsewhere that if the employer's plan does not meet the standard, you have the option to go out on the exchange.

and the PDF is labeled Enrollment Guide 2013 but inside in fine print there is a notice -

"Brochure effective for December 31, 2012"

which makes me think they still have last year's brochure posted, not the coverage for 2014.

Here's what the brochure states:


"Basic benefits to keep you well
See a doctor when you need to. Get preventive care to keep you and your family well.
With UnitedHealth Basics, many of your basic health care needs are covered, up to an annual limit for
each covered service.
What’s included in UnitedHealth Basics?
Covered services are available up to an annual limit for:
•Doctor’s
office
visits
•
In-network
preventive
care
is
covered
at
100%
with
no
annual
dollar
limit
•
Coverage
for
accidental
injuries
treated
in
the
Emergency
Department
•
Hospital
care
•
Outpatient
surgery
and
diagnostics
• Prescription
drugs
All plans include a nurse telephone hotline that you can call anytime, night or day. Just another tool to
help you make the most of your medical plan benefits.

It can't be $200.

So you're saying that you pay $200 a month in premiums but your annual limit is $200?

I think you're confused.

Here’s how this plan works
Option 1 Plan with low Rx, $30,000 in-patient hospital max
Weekly Rates:
Employee $25.59

The plan pays for maximum benefit per person per year in network payment out of network payment

annual deductible (does not apply to office visits $200 $200

Doctor’s Office Visits
Covers preventive care or
diagnosis and treatment of a
sickness or injury $200 You pay $15 per visit The plan pays 50%

Your annual DEDUCTIBLE is $200. Your in-patient max alone is $30,000.

Preventative care is covered at 100%.

if you're actually sick......

the maximum amount for doctor's visits is $200 per year. Down below, the maximum coverage for prescriptions is $500. ( )

Here's what it says elsewhere:

"This brochure contains information about UnitedHealth Basics. We encourage you to learn
about this limited health benefits program that can help you and your family stay healthy and
spend less on health care.

The plans give you coverage up to a set maximum amount per person per year for
common health care needs and preventive care.

where I'm too poor to be penalized for not having employer provided insurance, but too "rich" to get on a subsidized plan on the exchange. Try to figure that one out.

so I'm really hoping I can stay on my husband's plan. Even if I can't, my family still makes out better since two of my grown kids will be able to get decent coverage for the first time!

By law all policies have to meet minimum value, minimum essential coverage and affordability. Basically it's 60% of health care and the insured's policy for self only can't be above 9-1/2% of household income.

There are many ways to calculate all this. But this is the best way to find out. It has links that will help. Note the portion I've copied and pasted. The first link in it will help greatly.
http://www.lexology.com/library/detail.aspx?g=c2eec094-8da5-4014-ba18-ae614f4edde6

Summary of Benefits and Coverage

As reported in our July 19, 2012 Navigating Health Care Reform Alert, Summary of Benefits and Coverage for Group Health Plans, employers offering group health plan coverage are now required to provide their employees with an SBC. In addition to the summary plan description, the SBC summarizes the health plan or coverage offered by the employer and is intended to make it easier for employers to compare different plans and coverage.

In February 2012, the Department of Labor (“DOL”) published templates to be used for SBCs for health coverage beginning before January 1, 2014. When these templates were issued, the DOL indicated that it would update the SBC materials for subsequent years. Recently, the DOL released updated guidance in the form of Frequently Asked Questions and issued a new SBC template.

The new SBC template adds two important statements. The employer must include in the SBC (1) a statement as to whether the health plan provides minimum essential coverage, and (2) a statement as to whether the health plan meets the minimum value requirements. The updated template is authorized for use for coverage beginning on or after January 1, 2014 and before January 1, 2015.

The DOL has provided some transition relief for those employers that have already begun to prepare their SBCs for the 2014 plan year using the old template. If an employer is already in the process of preparing its SBC and the addition of the two statements regarding minimum essential coverage and minimum value would be an administrative burden, the employer does not have to include the statements in the SBC. However, in order to qualify for this relief, the employer must provide a cover letter or similar disclosure with its SBC indicating whether the plan provides minimum essential coverage and whether the plan meets the minimum value requirements. The Frequently Asked Questions guidance provides specific language to be included in the cover letter.

As a result of this new guidance, employers must update their SBCs with statements regarding minimum essential coverage and minimum value for coverage beginning on or after January 1, 2014. Most employers will have to update their SBCs to include the additional information for open enrollment in the fall of 2013, for the 2014 plan year. These statements can be provided by using the updated SBC template or as a disclosure provided in connection with the old SBC template.

The Kaiser Family Foundation also has a lot of very good information., It's their nonprofit research group.


http://kff.org/

into a plan with the new stuff like free preventives and relatively low deductibles and out-of-pocket caps.

People with employer based insurance can refuse that and get a plan the ACA applies to????

If you can get out from a crappy employer plan, I'd do it. Bankrupt those vampires.

but you will not be eligible for any premium subsidy.

so it allows your employer to do this. ACA is not in effect for employers until 2015, by decision of the Obama administration.

They just won't get fined if they don't offer any.

that may be a distinction without a difference!

in which case $200 doesn't sound crappy at all, depending on the coverage.

I imagine it would be already illegal to have a cap on benefits of $200 a year. It would be fraudulent to call that insurance.

From the brochure

"Remember,UnitedHealth Basics
provides limited coverage only. It
does not provide medical benefits
for a major illness.

**************************************
This policy allowed the company to advertise that they provide employees the opportunity to buy health insurance. IIRC, Walmart makes a similar claim for a crap policy. There's a reason the ACA sets minimum standards!

I'm pretty sure their coverage will go up, along with the premiums.

I was referred to so I could sign up on-line! Here's hoping someone screwed up royal!

Will be getting my plan details next week.