Individual Insuranc...
 

Individual Insurance in the VI  

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Alana33
(@Alana33)
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Joined: 7 years ago
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December 27, 2014 2:54 pm  

It would be wonderful to have affordable individual health-care insurance.


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East Ender
(@east-ender)
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December 27, 2014 3:11 pm  

Well, why do you reimburse more for PR providers?

I beg to differ about the increase in rate- it was MUCH more than 9%. Also, the co-pay went way up, essentially increasing the rate some more.

ACA compliant...there's the problem right there...


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OMARHAEDO
(@OMARHAEDO)
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December 27, 2014 3:15 pm  

I am happy to reply if you provide your actual name


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Alana33
(@Alana33)
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December 27, 2014 3:57 pm  

Actually, I think we'd all be curious for the response!


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speee1dy
(@speee1dy)
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December 27, 2014 5:49 pm  

i have bcbs through my work. ALL co pays for dr's are 50, deductibles are i think 1500 per person . blood work now costs, which i need a few times a year. mris cost as do ct scans 25% of cost after deductible is met. hospital 25% after deductible is met.

we went to Puerto Rico for hubbys surgery, total paid out for dr and hospital might have been ( between 4 visits so far ) 100 bucks. we get reimbursed 75 per flight. of course you have to pay for hotel and food and once in a while a taxi as a driver is usually available. for all 4 trips with everything included might have been 2000. most of that was the week of surgery for hotel and food. total. we saved a lot of money by going to pr for his surgery.

that is the only saving grace for this insurance,


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Spartygrad95
(@Spartygrad95)
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December 27, 2014 6:34 pm  

I have bcbs through work. My copays are $25/visit. Bloodwork is paid. Obviously there are different plans. My insurance here is FAR better than ACA plan I had from Humana in States. Cheaper. Covers more. Lower out of pocket expenses.


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speee1dy
(@speee1dy)
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December 27, 2014 8:11 pm  

wow, wish we had yours


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OMARHAEDO
(@OMARHAEDO)
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December 27, 2014 10:13 pm  

Yes, there are many plans available - from PLATINUM plans with no deductible and very low out of pocket costs from $550 per person per month average - to more cost effective options (and higher out of pocket costs) for $250 per person per month.

I can address the gentleman's specific question on the rates if he provides his personal information, yet the rates for 2015 are as I shared.

Out of pocket cost in PR reflect the cost of delivering care in that geography. Having the same copayment for PR (vs USA for example) means you're paying 100% of the cost. I've seen plans with a $40 copay for a office visit for PR and VI - while that looks fair and democratic, in essence, in PR, the member has no insurance so you're paying the entire cost of the medical care - and the cost of the "insurance"; seems unfair! don't you think?

So BCBS keeps the cost sharing as per the metal tiers (90% platinum; 80% gold; 70% silver and 60% bronze) and reflective of the local cost of care.

48.7% of Small employers in the USVI choose the silver plan (70% cost sharing plan)

Best regards to all.


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OMARHAEDO
(@OMARHAEDO)
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Joined: 5 years ago
Posts: 6
December 27, 2014 10:21 pm  

If any of you have questions regarding employer plans in the USVI - contact your local agent or BCBS USVI.

We're working VERY HARD on delivering on the individual plans - providing affordable health plans for individuals is a moral imperative - we will let you know soonest.

We're VERY close.

Cheers.


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East Ender
(@east-ender)
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Joined: 15 years ago
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December 28, 2014 3:14 pm  

I, for one, do NOT want to go to PR for any medical treatment. (td)


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janeinstx
(@janeinstx)
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Posts: 656
December 29, 2014 8:37 am  

I'd like to know why the insurance companies tolerate balance billing on prescription co-pays.


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OMARHAEDO
(@OMARHAEDO)
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Joined: 5 years ago
Posts: 6
December 29, 2014 12:34 pm  

Good morning! Perhaps we should start a healthcare forum! I don't want to portray that I have all the answers to all your questions. So I submit my best or suggested approach.

1. Yes, some people simply want to avoid or skirt PR - our open access plans (BCBS calls them Peak Plus) - allow the insured to go USA, VI or PR. All of these include MASA USA embedded in the policies.

2. As to 2 person groups - yes - we include HUSBAND AND WIFE - in the definition of small group - both have to work FT in the business and attest to this.

3. Back billing is a no-no; obtain a receipt and the details to BCBS customer care - the Pharmacy Benefit Manager (PBM in insurance 3 letter word-speak) - in our case is Catamaran - they have to go to the Pharmacy and - once facts are confirmed - tell them to stop and reimburse the patient.

Feel free to contact me at oohed@bcbsusvi.com and best wishes to all


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Spartygrad95
(@Spartygrad95)
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December 29, 2014 2:18 pm  

That email address isn't correct


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OMARHAEDO
(@OMARHAEDO)
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December 29, 2014 4:27 pm  

Oops - OHAEDO@BCBSUSVI.com


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vicanuck
(@vicanuck)
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Joined: 10 years ago
Posts: 2393
January 13, 2015 1:57 pm  

I thought this presentation on ObamaCare was very funny!

http://safeshare.tv/w/jyeqLxShwx


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janeinstx
(@janeinstx)
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January 13, 2015 6:18 pm  

.


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speee1dy
(@speee1dy)
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Joined: 11 years ago
Posts: 8741
January 13, 2015 8:18 pm  

it was nice going to PR for hubbys surgery. went on a friday for pre admissions stuff. spent the weekend doing fun stuff and then monday was surgery. kind of a mini vacation before the ick.


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tilloglobe
(@tilloglobe)
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Joined: 4 years ago
Posts: 1
October 15, 2015 5:41 pm  

Message Remove: Please revisit board rules.


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vasecs
(@vasecs)
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Joined: 10 years ago
Posts: 175
October 16, 2015 10:23 am  

I cannot get your address to work?


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OldTart
(@the-oldtart)
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Joined: 8 years ago
Posts: 6523
October 16, 2015 10:41 am  

I'd like to know what the poster/the company considers "expatriates" and the website doesn't address it (website address was corrected on another thread). US citizens in the USVI are NOT "expatriates". The spouse and family of a non-US citizen policy holder is covered by this sort of insurance but a US citizen resident of a US territory doesn't qualify - unless the company is misusing the "e" word. 😀


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rotorhead
(@rotorhead)
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Joined: 14 years ago
Posts: 2452
November 7, 2015 8:00 pm  

I guess he wasn't licensed after all.
http://stthomassource.com/content/news/local-news/2015/11/06/vi-issues-cease-and-desist-order-against-unlicensed-health-insure

Just updating everyone, we have a new site with instant quote. We offer HCI throughout the islands for any expats who have moved to the islands from the States or anywhere else. Carbbeanexpatmedicalgroup.com

We offer 25% off HCI Rates
Licensed Broker
Help with Claims
Low renewals
Many plan options
Co-pay options
30-60 days in the States
Travel & Dental Benefits
Group plans

We have been receiving complaints about claims not getting paid by insurance companies, it is important that you have someone on your side who have experience with Claim Paying and has experience to back you. I would not suggest buying from someone who does not have a license and years of experience in assisting with Claims Paying.

Cheers!

Rt

* Back to St John soon!

---------------------------------------------------------------------------
They say there's a heaven for those who will wait
Some say it's better but I say it ain't
I'd rather laugh with the sinners than cry with the saints
the sinners are much more fun...
You know that only the good die young.
BJ


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vicanuck
(@vicanuck)
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Joined: 10 years ago
Posts: 2393
November 8, 2015 12:07 am  

I really couldn't care less what the Lt Governor decrees. As long as the insurance company is paying the claims and not misrepresenting themselves so as to be fraudulent, I'm okay dealing with them.

I use Cigna Global for my expat coverage and its way cheaper because they don't have to jump through all those ACA hoops.

I highly doubt the Cigna Global, based in Glasgow, UK is licensed here either. But somehow I don't think they'd be too concerned with what bothers the Lt. Governor.

I can deal with any internet bank that isn't licensed or regulated in the VI and conduct banking transactions so whats the difference?


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Cat
 Cat
(@Cat)
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Joined: 8 years ago
Posts: 64
November 8, 2015 2:47 pm  

I can deal with any internet bank that isn't licensed or regulated in the VI and conduct banking transactions so whats the difference?

The difference is that if you get into a dispute with the locally unlicensed carrier, especially involving a high- or extended-cost injury or illness, you're in an even bigger world of hurt.


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CruzanIron
(@cruzaniron)
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Joined: 6 years ago
Posts: 2444
November 8, 2015 6:10 pm  

I can deal with any internet bank that isn't licensed or regulated in the VI and conduct banking transactions so whats the difference?

The difference is that if you get into a dispute with the locally unlicensed carrier, especially involving a high- or extended-cost injury or illness, you're in an even bigger world of hurt.

How would USAA fit into this?


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Cat
 Cat
(@Cat)
Advanced Member
Joined: 8 years ago
Posts: 64
November 8, 2015 10:26 pm  

As far as I know, USAA is fully licensed and authorized to offer automobile insurance in the USVI. They don't offer homeowners' for various reasons, probably due to the size of the market. Insofar as health insurance is concerned, they appear to offer it in only a subset of mainland states.

Health insurance and other types of insurance are addressed by often very different federal and state statutes, regulations, and case law. Some of these rules apply to how disputes are to be handled between the carrier and the insured person. If I were to be covered by a locally unlicensed health insurance carrier, I'd be pretty sure to check the policy to see the procedures for disputed claims and what jurisdiction's rules apply.


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