Quote:
Originally Posted by jkl2000
I confirmed that with my plan the deductible does restart when the new calendar year starts. But when you say above that the employer can choose when the deductible starts, if they were starting with a new plan mid-year and they chose calendar year for the deductible to restart, would the insurance company charge a lower premium for the year to reflect the shorter amount of time members had in which to meet their deductibles? In other words, WHY would an employer choose for the deductible to begin when the calendar year begins? The only reason I can think of is that the premiums would be lower for that first year, if in fact they are.
|
Your employer is likely self funded which means all the money to pay your claims comes from your employer not the third party administrator (company hired to administer the plan/process claims). There are no "premuims" involved when employer's are self funded. The TPA works for your employer just like you do. All the money to pay/fund our claims comes FROM your emoloyer.
Self funded plans either run on a Calendar year or a Plan year. The coverage period for both is 12 months.
It would be highly unusual for a self funded Plan to change administrators in middle of either the Plan or Calendar year (6 month mark) and if they did your employer would likely credit any amounts met toward deductible since it was in the same 12 month period.
If you are signing up for coverage in May when does the new Plan year actually begin? I would guess July 1st. Open enrollment (when you sign up for coverage) is typically is 2 months before the coverage actually takes effect. The new coverage does not become effective when you sign up during open enrollment. You only have to meet your deductible every 12 months
Whether you are covered by a Plan that runs on a Calendar year or a Plan year you have to meet your deductible every 12 months.
Some Plans have carryover deductible. If you meet the deductible in the last 3 months of the Calendar year (oct, Nov or dec) or the last 3 months of the Plan year it carries over to the next year. Most employer's have moved away from carry over deductibles.
Please register to participate in our discussions with 2 million other members - it's free and quick! Some forums can only be seen by registered members. After you create your account, you'll be able to customize options and access all our 15,000 new posts/day with fewer ads.
