EN,
I read your question and thought I should give you as comprehensive an answer as I can in 25 minutes:
1. All of the companies you mention are "reputable" and well financed. They all will have questionable claims payment reputations depending on who you talk to and what sort of service.
2. The key is to find out what providers in your area are taking, specifically the providers you and your family use. Almost everyone takes BC/BS Anthem, but you want to check. You don't want to switch companies and then find out your kids doctor and your wife's OB are not in their plan.
3. With regard to HMO/PPO etc, these plans are trending toward each other with respect to the service offering. This means these designations mean less and less and your best bet is to go "in network" on either plan type. Refer to #2 above.
4. The Average cost of a family health insurance plan is $15,000 annually. You can get them for less, and it is likely that a plan like the one you are considering should cost less than that. The actual cost will depend on the experience of the group at your company. Young groups that don't have health issues generally pay the lowest rates. Older, fatter groups tend to pay a lot more. The premium for your group is calculated each year in large part based on their claims experience.
5. If you go individual plan, you can save money if you maintain a relatively clean claims experience. The downside is that you will lost coverage for pre-existing conditions in most states for adults. Since Sep of 2010 pre-existing conditions for children cannot be the basis of excluded coverage. If you and your wife have no history of re-curring illness, this is a reasonable route to consider. In most instances an illness will not be considered a "pre-existing condition" unless you have experienced it in the last 18 months. However, the carrier can still consider it in their premium analysis. IF YOU HAVE PRE-EXISTING CONDITIONS I STRONGLY URGE YOU TO AVOID INDIVIDUAL PLANS IN STATES THAT ALLOW EXCLUSION OF PRE-EXISTINGS.
6. The real benefit of a group plan is two-fold. The first benefit is that as long as you had prior coverage and meet the eligibility requirements, you will be accepted to the plan with coverage for pre-existing conditions. The second benefit is that every member of the group pays the same fixed rates by election type: indivual, family, etc. The downside is for healthy people in plans with people who are less healthy -- which may be the case for your plan.
7. I have access to a BC/BS plan for small business that has fixed pricing no lifetime max, $400 deductible, $2,000 annual ind OOP, and includes a prescription plan that puts your cost for most drugs at 10% of actual cost. This plan costs just under $12,000 a year for a family regardless of health inventory as they don't require one. The drawback to the plan is that it is a bit higher than average cost for individuals $580 a month, and you have to have a minimum of two non-owner employees to join the plan.
8. Things to look at in your plan:
Lifetime Max: The trend it toward having no maximum, but I still see plans with a $250,000 max, which I think is criminal. A typical lifetime max is $5M to $8M. No max is preferable.
Individual/Family OOP: The OOP (Out of Pocket) is a maximum you will be required to pay in a single year through deductible and co-pay before services are paid 100%. Lousy plans never go to 100% coverage and should be avoided. There is usually both an individual and a family OOP maximum. Sometimes there is no family max, in which case the max is the individual max times the number of family members. I prefer a plan with both defined. Individual OOP ranges from $1,500 to $5,000 and obviously lower is better. Typical Family OOP are three times the individual OOP.
Provider Co-Pay: It is nice to have a co-pay for visits if it is in the alternative to the deductible, but its really a toss up. Compare what you are likely to do vs. the overall cost of the plan.
Deductible: The deductible generally applies to routine service, but not ER visits. Once its paid, you are reimbursed on a co-pay basis until you hit the applicable OOP maximum. If you have an 80% coverage plan before OOP is met, that means you pay 20 cents on the dollar until the OOP is reached, then you pay nothing. Deductible is one piece of your calculation when determining the annual cost of the plan. If you have kids count on blowing through several thousand dollars in services on routine dr. visits. A lower deductible isn't necessarily better -- especially if you put it together with a high OOP maximum.
Prescription Plan: Most health plans include prescriptions. If you take regular medications find out what the actual cost of the medication is. Most plans have a tiered co-pay that increases for medications that they assign to higher tiers. Insurance companies often make premium back by charging you a minimum co-pay that is often more than the cost of generic medicines. If you can find a plan that bases your Rx price on the price of the med, these are usually favorable.
9. Try to calculate an annual use cost for your family for any plan you look at. This will include the annual cost of the policy plus the amount you project to spend for deductibles, co-pays and whatever else you are gong to be stuck with. Taking a higher deductible to lower your premium may be a dollar to dollar trade-off that you don't want to make. Its all in the details.
to give a poster a reputation bump!