Health Insurance Annual Maximum reached?

Question

My family is on a health insurance policy through my husbands employer. At the time we signed up we didn't realize that this policy has an annual maximum of $3000. We have run through about $2000 already and will most definitely meet the annual max before the end of the year.

Will we still be required to make weekly payments although the insurance won't be paying any of our medical bills?

I really wish that we had known this before hand but none of the info that was given to us stated an annual maximum. We would have never signed up to pay them nearly $5000 to only get $3000 worth of coverage. It just doesn't make any sense for us to pay them another $2000 when they will not make any more payments for our medical expenses.

Answer 1

time to call your state insurance commisioner...ASAP something is wrong...

Answer 2

That doesn't make sense, most health insurance policies I have ever seen have a lifetime maximum of $1,000,000 or $2,000,000.  My goodness, a one night hospital stay is more than $3,000.  I would call the insurance company, have them explain your coverage to you in detail.  If you are truly paying $5,000 per year for $3,000 you would be better off getting something on your own.  I would also be reporting them to the State Insurance Dept.

Just a thought - is the $3,000 max a prescription maximum?  Or is it maximum "out of pocket" expense?  That means the maximum you have to pay per year & the insurance pays the rest.

Answer 3

Call the number on the back of your insurance card and have them explain the policy details. It sounds like the annual maximum is the maximum our out of pocket for you. That means after you spend that amount the insurance company will pay 100% of the bills after that. Keep in mind the annual max is usually based on each person covered with a maximum of 2 x $3,000.

Answer 4

This doesn't sound right.  I would recheck the information on your insurance policy and I would call them and get as many details as possible.  Then I would contact the State Medical Board and the like, to find out if what your insurance company is doing, is legal.

I wish you luck...

Answer 5

Yes, you will still be charge every month.  But relax, this is almost certainly a good thing.

When a health insurance policy talks about their annual maximum, it is talking about your Annual Out of Pocket Maximum.  Meaning once you have spent $3000, the majority of your medical care for the year will be covered at 100%.  

Call the number on the back of your insurance card for specifics on what will be covered at 100% and what you'll need to still send in copays for.

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If that's really the case where you are not getting coverage after $3000, then you'll want to cancel that policy. Unless it is a stipulation of your husband's job that he is enrolled on this plan, you should be able to cancel it without a problem.  

If that's the case, it doesn't sound like a real insurance plan: it sounds like an indemnity policy, and a bad one at that.  You will want to look into getting insurance, REAL insurance, preferably before you drop the one you currently have.  If you are in the state of California, feel free to contact me and I will be more than happy to help you through this.

Otherwise, look for an independent Agent who is an accredited member of the Better Business Bureau, has been around for at least 10 years, and has a reputation for excellent POST-SALE service.