Do I Lose My Cost Sharing I Paid When Switching Plans?
My insurance is through a ‘self-insured’ plan by county government which states:
Plan year begins Jan 1 – Dec 31st
Benefit year begins March 1 – Feb 28 of following year
Current plan SIHO……..benefit year is March 1, 2014 – Feb 28, 2015, but our deductibles/out of pocket continues from Jan 1 through the end of the year.
New Plan: Going from SIHO to Cigna (begins Mar 1 – Feb 28) now we’re told employees will be credited their deductible if they have met it toward the new plan, but not the out of pocket. This was only mentioned specifically on the out of pocket when I brought it up at a meeting, Feb 26th. Any amount an employee has accumulated we’re told will be lost! We have to sign up by today to get info in so cards can be printed.
The decision of the accepting of credit the deductible was made by the commissioners of the county per rep from Assured Neace Lukens. The rep informed me she did not know anything about the out of pocket, only the deductible credit. She stated, the commissioners would have to run the numbers (employees total out of pocket up to Feb 28th) to see if they would allow the rollover of this money to the new benefit year.
Under the new Affordable Care Act can this be done? Does having a self-insured insurance change the rules across the board? I would have never, ever planned any procedures, labs, etc. until I knew if the plan would remain the same.
I’ve worked elsewhere where open enrollment is done in late fall, and employees are given a lot more time than two days to decide. I asked the auditor if there was a reason why the plan year begins Jan 1, ends Dec 31st, and the benefit year starts March 1 through the following Feb 28th. She mentioned it has been done this way since they went self-insured in 1997. Not sure if it is done, because of not knowing their budgets. Can this be done earlier as to get this insurance under control?
I need answers quickly as I was told this out of pocket loss not being utilized today, and the new plan starts March 1st.
This is very disturbing, as I, along with others start the new year getting necessary testing done such as: colonoscopy, echo, etc. My husband met the $500 deductible, and has met part of the $1500.00 out of pocket. Now I’m told they will credit the $500.00, but will have to start all over again with OOP. Why was this not mentioned first of the year to employees if they go with a different carrier that our dollar amounts won’t continue as they did in the past? Of course they would not have known that at the time, but employees should have been given a heads-up, which was not the case.
In general, all private plans have adopted the calendar year as a policy period. This makes switching plans easy in regards to cost sharing. But if you switch mid-year, or to another insurance type which has different periods, you could certainly lose the amounts you paid into cost sharing. Also those who start a plan late in the year should be aware that they won't get the full value out of their cost sharing either.
grandfathered plans and some specific insurance types have special rules. Seems like they are trying to be cool by reimbursing you, but it is certainly a burn to think you are paying down your deductible only to have to start paying into cost sharing all over again. Generally, having different policy periods on different insurance types, and even with different insurers in the same market, really doesn't favor the policy holder at all.
Not sure what to tell you, but we will share your story and look at the law to see what rules are affecting this.