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Karen's High Dose Chemo Diary

Insurance Check-up

To: "wellness" < This e-mail address is being protected from spambots. You need JavaScript enabled to view it >
Subject: Insurance Check-up
From: "Harry Patterson" < This e-mail address is being protected from spambots. You need JavaScript enabled to view it >
Date: Tue, 12 Jan 1999 07:25:15 -0500


This message applies to everyone.

During our ventures through preparations for Karen's High Dose Chemo (HDC) trip to Duke we have had to take a long hard look at insurance. If you are like us, insurance has always been one of the expensive, never seem to use necessities of life that often gets relegated to the bottom of the pile. Well, it's time to take back out your paperwork and take a long hard look at what you have to see if you need more. Please consult with your own representatives, this information should not be construed as professional advice but simply a heads up for your information. This is long, but please read on, it applies to all.

Medical Insurance - The standard insurance most people have (or should have). Several key points to consider are what is your deductible, maximum out of pocket per year and maximum out of pocket per lifetime. It's easier than you might think to reach these maximums (1 test for Karen was $2000). For us, we have hit the maximum the past two years and will hit it this year in the first three months. What does this mean? If you have a $200 deductible then the first $200 in medical expenses covered by your plan will be paid by you, but still counted as towards your total insurance claims (file those forms). If you have an 80/20 co-insurance and a $1,700 maximum out of pocket then you will pay 20% of every bill until you have paid $1700 per year. So to reach your maximum you would need to  have medical bills of $7,700 ($200 deductible and 20% of $7500 is $1500). Remember 1 in 8 women will get breast cancer and we have reached our maximum every year since.

Several other key points to look for in your policy pertain to cancer and/or other diseases that require out of local area treatment. Our plan does not cover travel expense to/from hospital, lodging and meals for spouse during treatment, meals for patient if not received in hospital (Karen will be in outpatient at Hampton Inn for 2-4 weeks), any expenses for a caregiver that is not a required registered nurse (Duke requires a caregiver be with Karen for the 2-4 weeks and will be her sister). You may want to look in to cancer (or similar) policies designed to handle these expenses.

Long Term Disability (LTD) - According to Karen's insurance booklet "Every 2 seconds someone experiences a disabling injury. A disability is 16 times more likely to cause a mortgage foreclosure than death. One in 7 workers will become disabled for 5 years or more before age 65". This insurance is designed to help you protect a portion of your income if you become disabled. These plans have a benefit waiting period before you can collect which is often 90 days, so be prepared to have NO PAY during that period other than what you have in sick days and what your company will provide. After 90 days there is ONE BIG item to read carefully. If your company pays for your insurance any money received is taxable. If you pay for your insurance it will NOT be taxable (see your accountant). What this means for Karen's policy is the company pays the basic LTD and the policy will pay you a taxable 62.5% of your pay. If you made $1000 that would equate to $625 which if you are in the 20% bracket would yield a $500 pay (insurance) check. Her supplemental plan, which she pays for, pays 65% of her gross pay. Not much more except it is non-taxable and would yield a $650 payment. That's a $150 swing per pay. One final note on Long Term Disability - Your company is not obliged to keep your job after the 12 week FMLA period (see below) and you will have to pay your full medical insurance out of the LTD benefit after the 12 weeks. For Karen that's a swing of paying $50 per month with company assistance verses $270 per month during LTD. So in our example, if you had company paid LTD  your net pay on LTD would be $500-$135 (1/2 month insurance) or only $365. That means your pay might be reduced by $410/pay even having LTD. If you don't have LTD you will not receive a pay after 90 days (or your waiting period) have to pay out the $270 per month to retain your medical insurance. In short you should seriously look in to getting employee paid LTD.


Family Medical Leave Act (FMLA) - This e-mail has already gotten too long, but in short the FMLA passed by congress a few years ago provides protection of your job and your medical insurance benefits (you pay $25/pay vs. $130/pay in our example) for a period up to 12 weeks. Most companies require a letter requesting approval. This protects your insurance and your job NOT your pay.

Hope this helps. Sorry it was so long, but this can happen to you and does happen to 1 out of 7 people. Remember to talk with your employer, insurance representative and your accountant before it's too late.

Harry Patterson
Womens-Wellness.com

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